New South Wales Consolidated Regulations

CONSTITUTION (DISCLOSURES BY MEMBERS) REGULATION 1983 - SCHEDULE 1

SCHEDULE 1 – Forms

(Clauses 3 (1) and 3A)

Form 1 - Primary return

(Clause 3 (1), definition of “primary return”)

Note:

1 This form is in two sections. The first section (Section 1-Guidance Notes and Examples) outlines the requirements of the Constitution (Disclosures by Members) Regulation 1983 for each type of interest to be disclosed, and gives examples as to how to make entries on the return. The second section of the form (Section 2-Member’s Primary Return) sets out the return that is to be filled in by the Member. Only the second section of this form needs to be lodged with the Clerk.

2 The pecuniary interests and other matters required to be disclosed in the return set out in Section 2 of this form are prescribed in clauses 8, 9, 12, 13, 14 and 15A of the Constitution (Disclosures by Members) Regulation 1983 .

3 The particulars required to complete this form are to be written in block letters or typed.

4 If any space is insufficient in this form for all the particulars required to complete it, attach an appendix for that purpose which is properly identified and signed by the Member.

5 A reference in this form to the "primary return period" in relation to a Member is a reference to the period commencing on the day on which the Member took the pledge of loyalty and ending on the next succeeding 30th June.

6 If a Member is not required to disclose a kind of pecuniary interest or other matter under a particular main heading in this form, “NIL” or “N/A” (as relevant) is to be placed in an appropriate space under that heading.

7 The entries marked as “Example entry only” or “Example entries only” are provided by way of example only.

8 Matter marked with an asterisk (*) is to be omitted if it is not appropriate for the Member concerned.

Primary return

SECTION 1-GUIDANCE NOTES AND EXAMPLES

Part 1 Real property

Under clause 8 of the Constitution (Disclosures by Members) Regulation 1983 , you must disclose in Part 1 of the return the address of each parcel of real property in which you had an interest (or the alternative information permitted by the Regulation if you use the parcel for residential purposes) on the date on which you took the pledge of loyalty and the nature of the interest in the real property. Make a separate entry for each parcel of real property held, separated by a line, in Part 1 of the return.

Note:

Address of each parcel of real property	Nature of interest
Principal place of residence Suburb-Surry Hills	Joint tenant
1 Pitt Street, Sydney NSW 2000	Sole owner

Part 2 Sources of income

Under clause 9 of the Constitution (Disclosures by Members) Regulation 1983 , you must disclose in Part 2 of the return each source of income that you received, or reasonably expect to receive, during the primary return period. You must disclose income received, or which you expect to receive:

(a) as an employee, as part of a partnership, as an office holder (including an office holder in a corporation or body) or under any other contract, agreement or arrangement (such as a self-employed consultant/contractor) (use Part 2.1 of the return), and

(b) from a trust (use Part 2.2 of the return), and

(c) from any other source (use Part 2.3 of the return).

2.1 Income from employment, offices, partnerships and services Under clause 9 (2) (a)-(d) of the Constitution (Disclosures by Members) Regulation 1983 , you must disclose in Part 2.1 of the return any income you have received or reasonably expect to receive during the primary return period as an employee, as part of a partnership, as an office holder (including an office holder in a corporation or body) or under any other contract, agreement or arrangement (such as a self-employed consultant/contractor).
You must also describe the services you provide in receiving that income. The description of the services provided must be reasonably sufficient to identify the service provided in return for that income. Services from which you do not derive any income do not need to be disclosed.
You must make a separate entry for each different source of income in the appropriate Table in Part 2.1 of the return. For example, if you are employed and hold an office, two separate entries should be made respectively in Tables 2.1.1 and 2.1.2 in Part 2.1 of the return. Separate multiple entries in each Table by a line. Where the Table is not relevant to your circumstances because you do not receive that kind of income, enter “NIL” in that Table (for example, if you do not derive any income, whether as an employee, as an office holder, from a partnership or otherwise under a contract, agreement or arrangement, you must enter “NIL” in all Tables). Where the Table (or part of a Table) is not relevant to your circumstances because the conditions under which you would be required to make a disclosure do not apply in relation to you, enter “N/A” in that Table or part of the Table (for example, if you are not required to disclose the nature of the business of your employer because the services you provided did not arise from or relate to the use of your position as a Member).
Where you provide services that “arise from or relate to the use of” your position as a Member, you must complete the last column in each Table. This includes (but is not limited to) where you engage in:

(a) the provision of public policy advice, or

(b) the development of strategies or the provision of advice on the conduct of relations with the Government or Members, or

(c) lobbying the Government or other Members on a matter of concern to the person to whom the service is provided.

Note, where the provision of services “arise from or relate to the use of” your position as a Member, you may also need to complete Part 6 of the return.

Note:

Name of occupation	Description of kinds of services provided or to be provided	Name and address of employer	Nature of business of the employer (where the services provided or to be provided relate to your position as a Member)
Solicitor	Employed solicitor providing legal services to clients, in the areas of criminal and family law	ABC Lawyers, 1 Pitt Street, Sydney NSW 2000	N/A

Note:

Name or title of the office and a description of kinds of services provided or to be provided	Name and address of corporation or body (if any) in which the office is held	Nature of business carried on by the entity (where the services provided or to be provided relate to your position as a Member)
Local councillor	Hurstville City Council, MacMahon Street, Hurstville NSW 2220	N/A

Note:

Name of occupation (if any)	Description of kinds of services provided or to be provided	Name and address of the partnership	Nature of business carried on by the partnership (where the services provided or to be provided relate to your position as a Member)
Solicitor	Partner of the law firm and to provide commercial legal services specialising in litigation, property, intellectual property, competition and corporate law	XYZ Lawyer, 3 Smith Street, Paddington NSW 2021	N/A

Note:

Name of occupation (if relevant) and a description of services provided or to be provided	Name and address of parties to any contract, agreement or arrangement to provide services	Nature of business carried on by the other party to the contract, agreement or arrangement (where the services provided or to be provided relate to your position as a Member)
Public affairs consultant-Providing public affairs advice, including lobbying MPs and government departments on the issue of regulation of electrical appliances	XYZ Corporation, 1 Pitt Street, Sydney NSW 2000	Manufacturer of electrical appliances

2.2 Income from a trust Under clause 9 (2) (e) of the Constitution (Disclosures by Members) Regulation 1983 , you are required to disclose in Part 2.2 of the return any source of income which you received or reasonably expect to receive during the primary return period from a trust, including the name and address of the settlor and the trustee. Make a separate entry in Part 2.2 of the return (separated by a line) for each trust.

Note:

Name and address of settlor	Name and address of trustee
XY Settlor, 2 George Street, Sydney NSW 2000	AB Trustee, 10 George Street, Sydney NSW 2000

2.3 Other income Under clause 9 (2) (f) of the Constitution (Disclosures by Members) Regulation 1983 , you are required to disclose in Part 2.3 of the return any other income received or which you expect to receive during the primary return period and provide a description sufficient to identify the person from whom, or the circumstances in which, the income was, or is reasonably expected to be, received.

Note:

Disclosure of other income

Income from the operation of a farm at 1 Pitt Street, Orange NSW, 2800 of which I am the sole proprietor.

Part 3 Interests and positions in corporations

Under clause 12 of the Constitution (Disclosures by Members) Regulation 1983 , you must disclose in Part 3 of the return the following particulars for each corporation in which you had an interest or held any position (whether remunerated or not) on the date on which you took the pledge of loyalty:

(a) the name and address of each corporation,

(b) the nature of the interest (if any) or a description of the position held,

(c) except in the case of a listed public company, a description of the principal objects of each such corporation.

Note:

Name and address of corporation	Nature of interest (if any) or description of position held	Description of principal objects of corporation (where corporation is not a listed public company)
CD Corporation Limited, 1 Martin Place, Sydney NSW 2000	Shareholder	N/A
MD Corporation Pty Limited, 33 Kingsgrove Road, Kingsgrove NSW 2208	Majority shareholder	To provide financial advice to its clients

Part 4 Positions in trade unions and professional or business associations

Under clause 13 of the Constitution (Disclosures by Members) Regulation 1983 , you must disclose in Part 4 of the return the name of each trade union and professional or business association in which you held any position (whether remunerated or not) on the date on which you took the pledge of loyalty and a description of the position held.

Note:

Name of trade union or association	Description of position
ABC Trade Union	Member Honorary Secretary

Part 5 Debts

Under clause 14 of the Constitution (Disclosures by Members) Regulation 1983 , you must disclose in Part 5 of the return the name and address of each person to whom you were liable to pay any debt on the date on which you took the pledge of loyalty. You must disclose all debts, whether or not the amount to be paid was due and payable on the date on which you took the pledge of loyalty.
You do not need to disclose a debt that:

(a) does not exceed $500 unless the debt was 1 of 2 or more debts owed to 1 person and the amount of those 2 or more debts together exceeds $500 in aggregate, or

(b) is owed to a relative of yours (as defined by clause 7 (1) of the Constitution (Disclosures by Members) Regulation 1983 ), or

(c) is owed to a bank, building society, credit union or other person whose ordinary business includes the lending of money and the loan was made in the ordinary course of business of the lender, or

(d) arises from the supply of goods and services which were supplied in the 12 month period immediately preceding the primary return date, or

(e) arises from the supply of goods and services in the ordinary course of any occupation not related to your duties as a Member.

Note:

Disclosure of debts

Personal loan made by Mr John Smith of 1 Pitt Street, Sydney NSW 2000.

Part 6 Client services

Under clause 15A of the Constitution (Disclosures by Members) Regulation 1983 , you must disclose the details set out in Part 6 of the return if you have provided, or reasonably expect to provide, “client services” at any time during the primary return period.
Client services are provided by you if:

(a) you are engaged by a person (whether an individual or corporation) to provide services to or on behalf of any of that person’s clients, and

(b) that person has received or is reasonably expected to receive consideration in money or money’s worth from the client for your services, and

(c) the services relate to your Parliamentary position.

(a) any contract of employment with the person, or

(b) your role as an officer of the person (such as a corporation), or

(c) any other contract, agreement or arrangement that you have entered into with the person in respect of which you receive consideration in money, or money’s worth, for providing the services.

(a) the provision of public policy advice, or

(b) the development of strategies or the provision of advice on the conduct of relations with the Government or Members, or

(c) lobbying the Government or other Members on a matter of concern to the person to whom the service is provided.

Note:

Names and addresses of persons who benefit or are likely to benefit from the services	Description of the services reasonably sufficient to identify the nature of the service provided or to be provided	Nature of business of persons who directly benefited or are likely directly to benefit
Smith Constructions Pty Ltd, 1 Orange Street, Paddington NSW 2021	Advising on public policy regarding public infrastructure and the development of strategies on the conduct of relations with the Government, and lobbying government departments in relation to projects managed by the company	Construction company specialising in public infrastructure such as roads

Part 7 Discretionary disclosures

Under clause 16 of the Constitution (Disclosures by Members) Regulation 1983 , a Member may disclose in Part 7 of the return any direct or indirect benefits, advantages or liabilities that are not required to be disclosed by the Regulation but which the Member considers might appear to raise a conflict between his or her private interests and his or her public duty as a Member or which he or she otherwise wishes to disclose.

Primary return

SECTION 2-MEMBER’S PRIMARY RETURN

Primary return

Constitution (Disclosures by Members) Regulation 1983

Primary return

Primary Return-Legislative *Council/*Assembly

Disclosures of pecuniary interests and other matters by:

Part 1 Real property

Part 2 Sources of income

2.1 Income from employment, offices, partnerships and services

Table 2.1.1 Income received as an employee

Name of occupation	Description of kinds of services provided or to be provided	Name and address of employer	Nature of business of the employer (where the services provided or to be provided relate to your position as a Member)

Table 2.1.2 Income received as holder of office

Name or title of the office and a description of kinds of services provided or to be provided	Name and address of corporation or body (if any) in which the office is held	Nature of business carried on by the entity (where the services provided or to be provided relate to your position as a Member)

Table 2.1.3 Income from partnership

Name of occupation (if any)	Description of kinds of services provided or to be provided	Name and address of the partnership	Nature of business carried on by the partnership (where the services provided or to be provided relate to your position as a Member)

Table 2.1.4 Income from services provided under any other contract, agreement or arrangement

Name of occupation (if relevant) and a description of services provided or to be provided	Name and address of parties to any contract, agreement or arrangement to provide services	Nature of business carried on by the other party to the contract, agreement or arrangement (where the services provided or to be provided relate to your position as a Member)

2.2 Income from a trust

2.3 Other income

Part 3 Interests and positions in corporations

Part 4 Positions in trade unions and professional or business associations

Part 5 Debts

Part 6 Client services

Part 7 Discretionary disclosures

Form 2 - Ordinary return

(Clause 3 (1), definition of “ordinary return”)

Note:

1 This form is in two sections. The first section (Section 1-Guidance Notes and Examples) outlines the requirements of the Constitution (Disclosures by Members) Regulation 1983 for each type of interest to be disclosed, and gives examples as to how to make entries on the return. The second section of the form (Section 2-Member’s Ordinary Return) sets out the return that is to be filled in by the Member. Only the second section of this form needs to be lodged with the Clerk.

2 The pecuniary interests and other matters required to be disclosed in the return set out in Section 2 of this form are prescribed by clauses 8 to 15A of the Constitution (Disclosures by Members) Regulation 1983 .

3 The particulars required to complete this form are to be written in block letters or typed.

4 If any space is insufficient in this form for all the particulars required to complete it, attach an appendix for that purpose which is properly identified and signed by the Member.

5 A reference in this form to the "ordinary return period" in relation to a Member is a reference to:

(a) where the last return lodged by the Member was an ordinary return-the period of 12 months ending on 30th June in the year this return is required to be lodged, or

(b) where the last return lodged by the Member was a primary return-the period commencing on the day on which the Member took the pledge of loyalty and ending on 30th June in the year this return is required to be lodged.

6 If a Member is not required to disclose a kind of pecuniary interest or other matter under a particular main heading in this form, “NIL” or “N/A” (as relevant) is to be placed in an appropriate space under that heading.

7 The entries marked as “Example entry only” or “Example entries only” are provided by way of example only.

8 You must disclose ALL matters required to be disclosed as set out in the return in Section 2 of this form (and as required by the

9 Matter marked with an asterisk (*) is to be omitted if it is not appropriate for the Member concerned.

Ordinary return

SECTION 1-GUIDANCE NOTES AND EXAMPLES

Part 1 Real property

Under clause 8 of the Constitution (Disclosures by Members) Regulation 1983 , you must disclose in Part 1 of the return the address of each parcel of real property in which you had an interest (or the alternative information permitted by the Regulation if you used the parcel for residential purposes) at any time during the ordinary return period and the nature of the interest in the real property. Make a separate entry for each parcel of real property held, separated by a line, in Part 1 of the return.

Note:

Address of each parcel of real property	Nature of interest
Principal place of residence Suburb-Surry Hills	Joint tenant
1 Pitt Street, Sydney NSW 2000	Sole owner

Part 2 Sources of income

Under clause 9 of the Constitution (Disclosures by Members) Regulation 1983 , you must disclose in Part 2 of the return each source of income that you received during the ordinary return period. You must disclose income received:

(a) as an employee, as part of a partnership, as an office holder (including an office holder in a corporation or body) or under any other contract, agreement or arrangement (such as a self-employed consultant/contractor) (use Part 2.1 of the return), and

(b) from a trust (use Part 2.2 of the return), and

(c) from any other source (use Part 2.3 of the return).

2.1 Income from employment, offices, partnerships and services Under clause 9 (2) (a)-(d) of the Constitution (Disclosures by Members) Regulation 1983 , you must disclose in Part 2.1 of the return any income you have received during the ordinary return period as an employee, as part of a partnership, as an office holder (including an office holder in a corporation or body) or under any other contract, agreement or arrangement (such as a self-employed consultant/contractor).
You must also describe the services you provide in receiving that income. The description of the services provided must be reasonably sufficient to identify the service provided in return for that income. Services from which you do not derive any income do not need to be disclosed.
You must make a separate entry for each different source of income in the appropriate Table in Part 2.1 of the return. For example, if you are employed and hold an office, two separate entries should be made respectively in Tables 2.1.1 and 2.1.2 in Part 2.1 of the return. Separate multiple entries in each Table by a line. Where the Table is not relevant to your circumstances because you do not receive that kind of income, enter “NIL” in that Table (for example, if you do not derive any income, whether as an employee, as an office holder, from a partnership or otherwise under a contract, agreement or arrangement, you must enter “NIL” in all Tables). Where the Table (or part of a Table) is not relevant to your circumstances because the conditions under which you would be required to make a disclosure do not apply in relation to you, enter “N/A” in that Table or part of the Table (for example, if you are not required to disclose the nature of the business of your employer because the services you provided did not arise from or relate to the use of your position as a Member).
Where you provide services that “arise from or relate to the use of” your position as a Member, you must complete the last column in each Table. This includes (but is not limited to) where you engage in:

(a) the provision of public policy advice, or

(b) the development of strategies or the provision of advice on the conduct of relations with the Government or Members, or

(c) lobbying the Government or other Members on a matter of concern to the person to whom the service is provided.

Note, where the provision of services “arise from or relate to the use of” your position as a Member, you may also need to complete Part 9 of the return.

Note:

Name of occupation	Description of kinds of services provided	Name and address of employer	Nature of business of the employer (where the services provided relate to your position as a Member)
Solicitor	Employed solicitor providing legal services to clients, in the areas of criminal and family law	ABC Lawyers, 1 Pitt Street, Sydney NSW 2000	N/A

Note:

Name or title of the office and a description of kinds of services provided	Name and address of corporation or body (if any) in which the office is held	Nature of business carried on by the entity (where the services provided relate to your position as a Member)
Local councillor	Hurstville City Council, MacMahon Street, Hurstville NSW 2220	N/A

Note:

Name of occupation (if any)	Description of kinds of services provided	Name and address of the partnership	Nature of business carried on by the partnership (where the services provided relate to your position as a Member)
Solicitor	Partner of the law firm and to provide commercial legal services specialising in litigation, property, intellectual property, competition and corporate law	XYZ Lawyer, 3 Smith Street, Paddington NSW 2021	N/A

Note:

Name of occupation (if relevant) and a description of services provided	Name and address of parties to any contract, agreement or arrangement to provide services	Nature of business carried on by the other party to the contract, agreement or arrangement (where the services provided relate to your position as a Member)
Public affairs consultant-Providing public affairs advice, including lobbying MPs and government departments on the issue of regulation of electrical appliances	XYZ Corporation, 1 Pitt Street, Sydney NSW 2000	Manufacturer of electrical appliances

2.2 Income from a trust Under clause 9 (2) (e) of the Constitution (Disclosures by Members) Regulation 1983 , you are required to disclose in Part 2.2 of the return any source of income which you received during the ordinary return period from a trust, including the name and address of the settlor and the trustee. Make a separate entry in Part 2.2 of the return (separated by a line) for each trust.

Note:

Name and address of settlor	Name and address of trustee
XY Settlor, 2 George Street, Sydney NSW 2000	AB Trustee, 10 George Street, Sydney NSW 2000

2.3 Other income Under clause 9 (2) (f) of the Constitution (Disclosures by Members) Regulation 1983 , you are required to disclose in Part 2.3 of the return any other income received during the ordinary return period and provide a description sufficient to identify the person from whom, or the circumstances in which, the income was received.

Note:

Disclosure of other income

Income from the operation of a farm at 1 Pitt Street, Orange NSW 2800 of which I am the sole proprietor.

Part 3 Gifts

Under clause 10 of the Constitution (Disclosures by Members) Regulation 1983 , you are required to disclose in Part 3 of the return any gifts (including gifts of cash) received during the ordinary return period and the name and address of the person from whom the gift was received.
You do not need to disclose a gift that:

(a) does not exceed $500 in value unless the gift was 1 of 2 or more gifts made by 1 person at any time during the ordinary return period and the amount of those 2 or more gifts together exceeds $500 in aggregate, or

(b) is a political donation disclosed, or required to be disclosed, under Part 6 of the Election Funding Act 1981 , or

(c) is from a donor who is a relative of yours (as defined by clause 7 (1) of the Constitution (Disclosures by Members) Regulation 1983 ).

Note:

Description of each gift I received at any time during the ordinary return period	Name and address of donor
4 tickets to the XYZ sporting event	XYZ Sports Union, 1 Pitt Street, Sydney NSW 2000

Part 4 Contributions to travel

Under clause 11 of the Constitution (Disclosures by Members) Regulation 1983 , you are required to disclose the information set out in Part 4 of the return for any contribution to any travel (including accommodation incidental to a journey) undertaken by you during the ordinary return period.
You do not need to disclose a contribution if:

(a) the contribution was made from public funds (including a contribution arising from travel on free passes issued under any Act or from travel in government vehicles), or

(b) the contribution was made by a relative of yours (as defined by clause 7 (1) of the Constitution (Disclosures by Members) Regulation 1983 ), or

(c) the contribution was made in the ordinary course of any occupation which is not related to your duties as a Member, or

(d) the amount of the contribution did not exceed $250 unless the contribution was 1 of 2 or more contributions made by 1 person at any time during the ordinary return period and the amount of those 2 or more contributions exceeded, in the aggregate, $250, or

(e) the contribution was a political contribution disclosed, or required to be disclosed, under Part 6 of the Election Funding Act 1981 , or

(f) the contribution was made by a political party of which you are a member and the travel was undertaken for the purpose of political activity of the party in New South Wales or to enable you to represent the party within Australia.

Note:

Name and address of each person who made any financial or other contribution to travel undertaken at any time during the ordinary return period	Dates on which travel was taken	Names of States, Territories of the Commonwealth and overseas countries in which travel undertaken
Brisbane City Council, 1 Smith Street, Brisbane QLD 4000	31 August to 4 September	Brisbane, Queensland

Part 5 Interests and positions in corporations

Under clause 12 of the Constitution (Disclosures by Members) Regulation 1983 , you must disclose in Part 5 of the return the following particulars for each corporation in which you had an interest or held any position (whether remunerated or not) at any time during the ordinary return period:

(a) the name and address of each corporation,

(b) the nature of the interest (if any) or a description of the position held,

(c) except in the case of a listed public company, a description of the principal objects of each such corporation.

Note:

Name and address of corporation	Nature of interest (if any) or description of position held	Description of principal objects of corporation (where corporation is not a listed public company)
CD Corporation Limited, 1 Martin Place, Sydney NSW 2000	Shareholder	N/A
MD Corporation Pty Limited, 33 Kingsgrove Road, Kingsgrove NSW 2208	Majority shareholder	To provide financial advice to its clients

Part 6 Positions in trade unions and professional or business associations

Under clause 13 of the Constitution (Disclosures by Members) Regulation 1983 , you must disclose in Part 6 of the return the name of each trade union and professional or business association in which you held any position (whether remunerated or not) at any time during the ordinary return period and a description of the position held.

Note:

Name of trade union or association	Description of position
ABC Trade Union	Member Honorary Secretary

Part 7 Debts

Under clause 14 of the Constitution (Disclosures by Members) Regulation 1983 , you must disclose in Part 7 of the return the name and address of each person to whom you were liable to pay any debt at any time during the ordinary return period. You must disclose all debts, whether or not the amount to be paid was due and payable at any time during that period.
You do not need to disclose a debt that:

(a) does not exceed $500 unless the debt was 1 of 2 or more debts owed to 1 person and the amount of those 2 or more debts together exceeds $500 in aggregate, or

(b) is owed to a relative of yours (as defined by clause 7 (1) of the Constitution (Disclosures by Members) Regulation 1983 ), or

(c) is owed to a bank, building society, credit union or other person whose ordinary business includes the lending of money and the loan was made in the ordinary course of business of the lender, or

(d) arises from the supply of goods and services which were supplied during the ordinary return period, or

(e) arises from the supply of goods and services in the ordinary course of any occupation not related to your duties as a Member.

Note:

Disclosure of debts

Personal loan made by Mr John Smith of 1 Pitt Street, Sydney NSW 2000.

Part 8 Dispositions of property

Under clause 15 of the Constitution (Disclosures by Members) Regulation 1983 , you must disclose in Part 8 of the return particulars of each disposition of:

(a) real property by you at any time during the ordinary return period whereby you retained, wholly or in part, the use and benefit of the property or the right to reacquire the property at a later time, or

(b) property to a person by any other person under arrangements made by you during the ordinary return period whereby you obtained, either wholly or in part, the use and benefit of the property.

Note:

Disclosure of dispositions of property

Disposition of Lot 5, DP1234 on 30 May to XYZ Corporation, whereby a right is conferred on Mr Smith MP to use the property.

Part 9 Client services

Under clause 15A of the Constitution (Disclosures by Members) Regulation 1983 , you must disclose the details set out in Part 9 of the return if you have provided “client services” at any time during the ordinary return period.
Client services are provided by you if:

(a) you are engaged by a person (whether an individual or corporation) to provide services to or on behalf of any of that person’s clients, and

(b) that person has received or is reasonably expected to receive consideration in money or money’s worth from the client for your services, and

(c) the services relate to your Parliamentary position.

(a) any contract of employment with the person, or

(b) your role as an officer of the person (such as a corporation), or

(c) any other contract, agreement or arrangement that you have entered into with the person in respect of which you receive consideration in money, or money’s worth, for providing the services.

(a) the provision of public policy advice, or

(b) the development of strategies or the provision of advice on the conduct of relations with the Government or Members, or

(c) lobbying the Government or other Members on a matter of concern to the person to whom the service is provided.

Note:

Names and addresses of persons who benefit or are likely to benefit from the services provided at any time during the ordinary return period	Description of the services reasonably sufficient to identify the nature of the service provided	Nature of business of persons who directly benefited or are likely directly to benefit
Smith Constructions Pty Ltd, 1 Orange Street, Paddington NSW 2021	Advising on public policy regarding public infrastructure and the development of strategies on the conduct of relations with the Government, and lobbying government departments in relation to projects managed by the company	Construction company specialising in public infrastructure such as roads

Part 10 Discretionary disclosures

Under clause 16 of the Constitution (Disclosures by Members) Regulation 1983 , a Member may disclose in Part 10 of the return any direct or indirect benefits, advantages or liabilities that are not required to be disclosed by the Regulation but which the Member considers might appear to raise a conflict between his or her private interests and his or her public duty as a Member or which he or she otherwise wishes to disclose.

Ordinary return

SECTION 2-MEMBER’S ORDINARY RETURN

Ordinary return

Constitution (Disclosures by Members) Regulation 1983

Ordinary return

Ordinary Return-Legislative *Council/*Assembly

Disclosures of pecuniary interests and other matters by:

(full name of Member)

in respect of the period fromto

(ordinary return period)

Part 1 Real property

Part 2 Sources of income

2.1 Income from employment, offices, partnerships and services

Table 2.1.1 Income received as an employee

Name of occupation	Description of kinds of services provided	Name and address of employer	Nature of business of the employer (where the services provided relate to your position as a Member)

Table 2.1.2 Income received as holder of office

Name or title of the office and a description of kinds of services provided	Name and address of corporation or body (if any) in which the office is held	Nature of business carried on by the entity (where the services provided relate to your position as a Member)

Table 2.1.3 Income from partnership

Name of occupation (if any)	Description of kinds of services provided	Name and address of the partnership	Nature of business carried on by the partnership (where the services provided relate to your position as a Member)

Table 2.1.4 Income from services provided under any other contract, agreement or arrangement

Name of occupation (if relevant) and a description of services provided	Name and address of parties to any contract, agreement or arrangement to provide services	Nature of business carried on by the other party to the contract, agreement or arrangement (where the services provided relate to your position as a Member)

2.2 Income from a trust

2.3 Other income

Part 3 Gifts

Part 4 Contributions to travel

Part 5 Interests and positions in corporations

Part 6 Positions in trade unions and professional or business associations

Part 7 Debts

Part 8 Dispositions of property

Part 9 Client services

Part 10 Discretionary disclosures

Form 3 - Supplementary ordinary return

(Clause 3 (1), definition of “supplementary ordinary return”)

Note:

1 This form is in two sections. The first section (Section 1-Guidance Notes and Examples) outlines the requirements of the Constitution (Disclosures by Members) Regulation 1983 for each type of interest to be disclosed, and gives examples as to how to make entries on the return. The second section of the form (Section 2-Member’s Supplementary Ordinary Return) sets out the return that is to be filled in by the Member. Only the second section of this form needs to be lodged with the Clerk.

2 The pecuniary interests and other matters required to be disclosed in the return set out in Section 2 of this form are prescribed by clauses 8 to 15A of the Constitution (Disclosures by Members) Regulation 1983 (as applied to the return by clause 6A of the Regulation).

3 You must complete EITHER Division A or Division B of the return in Section 2.

4 The particulars required to complete this form are to be written in block letters or typed.

5 If any space is insufficient in this form for all the particulars required to complete it, attach an appendix for that purpose which is properly identified and signed by the Member.

6 You should refer to the Constitution (Disclosures by Members) Regulation 1983 and the instructions in your last ordinary return (if any) to identify whether pecuniary interests should be disclosed.

7 A reference in this form to the "supplementary ordinary return period" in relation to a Member is a reference to:

(a) in the case of a Member whose previous return was an ordinary return-the period commencing on 1st July and ending on 31st December of the previous year, or

(b) in  the case of a Member whose previous return was a primary return:

(i) where the Member took the pledge of loyalty on or before 1st July of the previous year-the period commencing on 1st July and ending on 31st December of the previous year, or

(ii) where the Member took the pledge of loyalty after 1st July of the previous year-the period commencing on that date and ending on 31st December in the previous year.

8 The entries marked as “Example entry only” or “Example entries only” are provided by way of example only.

9 Matter marked with an asterisk (*) is to be omitted if it is not appropriate for the Member concerned.

Supplementary ordinary return

SECTION 1-GUIDANCE NOTES AND EXAMPLES

1 A supplementary ordinary return is designed to update the pecuniary interests disclosed in the ordinary return or primary return last filed by you that covered the return period ending on 30 June last year. Specifically, the purpose of this form is for you to identify additional pecuniary interests for the period 1 July to 31 December of last year. The return must generally be filed by 31 March. Certain interests do not need to be disclosed if they have been disclosed in your most recent ordinary return or primary return.

2 In the case of new Members (other than re-elected Members) who have not yet filed an ordinary return, your primary return is to be treated as your most recent ordinary return for the purposes of completing this supplementary ordinary return. It should also be noted that new Members do not need to disclose anything that occurred, or was received or had, before the date on which the pledge of loyalty was taken. Also, as a result of this, some new Members will have a supplementary ordinary return period that is shorter than the period 1 July to 31 December of last year.

3 Additional pecuniary interests must be disclosed where, during the supplementary ordinary return period, you have:

(a) held any interests in real property, which are additional to those already disclosed in your most recent return, or

(b) received income from any source, or

(c) received any gifts or contributions to travel, or

(d) held any interests or positions in corporations, which are additional to those already disclosed in your most recent return, or

(e) held any positions in trade unions or professional or business associations, which are additional to those already disclosed in your most recent ordinary return, or

(f) incurred a liability to pay a debt to any person, which is additional to those already disclosed in your most recent ordinary return, or

(g) had any dispositions of property (within the meaning of Part 3 of the Constitution (Disclosures by Members) Regulation 1983 ) in which you have retained a benefit, or

(h) provided any “client services”.

4 Complete either Division A or Division B of the return, but not both.
Division A must only be completed where, in respect of the supplementary ordinary return period last year, you do not have any additional pecuniary interests to disclose as required by the Constitution (Disclosures by Members) Regulation 1983 .
Division B must only be completed if you have additional pecuniary interests set out in item 3 (a) to (h) of these notes in respect of the supplementary ordinary return period last year. You must identify each of the additional pecuniary interest in the relevant table in Division B. You must disclose the following kinds of pecuniary interests even if you disclosed them in the same or a similar entry in your most recent return:

(a) income received from any source,

(b) any gifts or contributions to travel that you received,

(c) any dispositions of property (within the meaning of Part 3 of the Constitution (Disclosures by Members) Regulation 1983 ),

(d) any “client services” you provided.

5 If you are not required to disclose a kind of pecuniary interest or other matter under a particular main heading in Division B, “NIL” or “N/A” (as relevant) is to be placed in an appropriate space under that heading.

6 If you have ceased to hold a pecuniary interest that you disclosed in your most recent ordinary return (for example, you have divested yourself of real property), you may (but are not required to) attach a separate document identifying those pecuniary interests that you have ceased to hold.

Part 1 Real property

List in Part 1 in Division B of the return any interests in real property you held during the supplementary ordinary return period, which are additional to those that you have already disclosed in your most recent return.

Note:

Address of each parcel of real property	Nature of interest
Principal place of residence Suburb-Surry Hills	Joint tenant
1 Pitt Street, Sydney NSW 2000	Sole owner

Part 2 Sources of income

List in Part 2 in Division B of the return all sources from which you received income during the supplementary ordinary return period. You must list all sources of income for that period, even if you listed the same or a similar matter in your most recent return for the previous return period.

2.1 Income from employment, offices, partnerships and services List in the appropriate Tables in Part 2.1 in Division B of the return income from employment, offices, partnerships and services.

Note:

Name of occupation	Description of kinds of services provided	Name and address of employer	Nature of business of the employer (where the services provided relate to your position as a Member)
Solicitor	Employed solicitor providing legal services to clients, in the areas of criminal and family law	ABC Lawyers, 1 Pitt Street, Sydney NSW 2000	N/A

Note:

Name or title of the office and a description of kinds of services provided	Name and address of corporation or body (if any) in which the office is held	Nature of business carried on by the entity (where the services provided relate to your position as a Member)
Local councillor	Hurstville City Council, MacMahon Street, Hurstville NSW 2220	N/A

Note:

Name of occupation (if any)	Description of kinds of services provided	Name and address of the partnership	Nature of business carried on by the partnership (where the services provided relate to your position as a Member)
Solicitor	Partner of the law firm and to provide commercial legal services specialising in litigation, property, intellectual property, competition and corporate law	XYZ Lawyer, 3 Smith Street, Paddington NSW 2021	N/A

Note:

Name of occupation (if relevant) and a description of services provided	Name and address of parties to any contract, agreement or arrangement to provide services	Nature of business carried on by the other party to the contract, agreement or arrangement (where the services provided relate to your position as a Member)
Public affairs consultant-Providing public affairs advice, including lobbying MPs and government departments on the issue of regulation of electrical appliances	XYZ Corporation, 1 Pitt Street, Sydney NSW 2000	Manufacturer of electrical appliances

2.2 Income from a trust List in Part 2.2 in Division B of the return any income from trusts.

Note:

Name and address of settlor	Name and address of trustee
XY Settlor, 2 George Street, Sydney NSW 2000	AB Trustee, 10 George Street, Sydney NSW 2000

2.3 Other income List in Part 2.3 in Division B of the return any other income.

Note:

Disclosure of other income

Income from the operation of a farm at 1 Pitt Street, Orange NSW, 2800 of which I am the sole proprietor.

Part 3 Gifts

List in Part 3 in Division B of the return all gifts you received during the supplementary ordinary return period. You must list all gifts for that period, even if you listed the same or a similar matter in your most recent return for the previous return period.

Note:

Description of each gift I received at any time during the supplementary ordinary return period	Name and address of donor
4 tickets to the XYZ sporting event	XYZ Sports Union, 1 Pitt Street, Sydney NSW 2000

Part 4 Contributions to travel

List in Part 4 in Division B of the return all contributions to travel you received during the supplementary ordinary return period. You must list all contributions to travel for that period, even if you listed the same or a similar matter in your most recent return for the previous return period.

Note:

Name and address of each person who made any financial or other contribution to travel undertaken at any time during the supplementary ordinary return period	Dates on which travel was taken	Names of States, Territories of the Commonwealth and overseas countries in which travel undertaken
Brisbane City Council, 1 Smith Street, Brisbane QLD 4000	31 August to 4 September	Brisbane, Queensland

Part 5 Interests and positions in corporations

List in Part 5 in Division B of the return all positions or interests in corporations you held during the supplementary ordinary return period that are additional to those positions or interests that you have already disclosed in your most recent return. If you received income in respect of any position held in a corporation, that information should be disclosed in Part 2 in Division B of the return.

Note:

Name and address of corporation	Nature of interest (if any) or description of position held	Description of principal objects of corporation (where corporation is not a listed public company)
CD Corporation Limited, 1 Martin Place, Sydney NSW 2000	Shareholder	N/A
MD Corporation Pty Limited, 33 Kingsgrove Road, Kingsgrove NSW 2208	Majority shareholder	To provide financial advice to its clients

Part 6 Positions in trade unions and professional or business associations

List in Part 6 in Division B of the return all positions in trade unions and professional or business associations you held during the supplementary ordinary return period that are additional to those positions or interests that you have already disclosed in your most recent return.

Note:

Name of trade union or association	Description of position
ABC Trade Union	Member Honorary Secretary

Part 7 Debts

List in Part 7 in Division B of the return the name and address of persons to whom you were liable for a debt during the supplementary ordinary return period that are additional to those which you have already listed in your most recent return.

Note:

Disclosure of debts

Personal loan made by Mr John Smith of 1 Pitt Street, Sydney NSW 2000.

Part 8 Dispositions of property

List in Part 8 in Division B of the return all dispositions of property (within the meaning of Part 3 of the Constitution (Disclosures by Members) Regulation 1983 ) in which you have retained a benefit during the supplementary ordinary return period. You must list all such dispositions occurring during that period, even if you listed the same or a similar matter in your most recent return for the previous return period.

Note:

Disclosure of dispositions of property

Disposition of Lot 5, DP1234 on 30 May to XYZ Corporation, whereby a right is conferred on Mr Smith MP to use the property.

Part 9 Client services

List in Part 9 in Division B of the return all client services you provided during the supplementary ordinary return period. You must list all client services provided during that period, even if you listed the same or a similar matter in your most recent return for the previous return period.

Note:

Names and addresses of persons who benefit or are likely to benefit from the services provided at any time during the supplementary ordinary return period	Description of the services reasonably sufficient to identify the nature of the service provided	Nature of business of persons who directly benefited or are likely directly to benefit
Smith Constructions Pty Ltd, 1 Orange Street, Paddington NSW 2021	Advising on public policy regarding public infrastructure and the development of strategies on the conduct of relations with the Government, and lobbying government departments in relation to projects managed by the company	Construction company specialising in public infrastructure such as roads

Part 10 Discretionary disclosures

List in Part 10 any other disclosures you wish to make.

Supplementary ordinary return

SECTION 2-MEMBER’S SUPPLEMENTARY ORDINARY RETURN

Supplementary ordinary return

Constitution (Disclosures by Members) Regulation 1983

Supplementary ordinary return

Supplementary Ordinary Return-Legislative *Council/*Assembly

*Division A

Disclosures of pecuniary interests and other matters by:

(full name of Member)
I certify that there are no new pecuniary interests that I need to disclose as required by clause 6A of the Constitution (Disclosures by Members) Regulation 1983 in respect of the period fromto
(supplementary ordinary return period)

*Division B

Disclosures of pecuniary interests and other matters by:

(full name of Member)
I certify that the additional pecuniary interests set out in the Parts to this Division are the interests that I am required to disclose by clause 6A of the Constitution (Disclosures by Members) Regulation 1983
in respect of the period fromto
(supplementary ordinary return period)

Part 1 Real property

Part 2 Sources of income

2.1 Income from employment, offices, partnerships and services

Table 2.1.1 Income received as an employee

Name of occupation	Description of kinds of services provided	Name and address of employer	Nature of business of the employer (where the services provided relate to your position as a Member)

Table 2.1.2 Income received as holder of office

Name or title of the office and a description of kinds of services provided	Name and address of corporation or body (if any) in which the office is held	Nature of business carried on by the entity (where the services provided relate to your position as a Member)

Table 2.1.3 Income from partnership

Name of occupation (if any)	Description of kinds of services provided	Name and address of the partnership	Nature of business carried on by the partnership (where the services provided relate to your position as a Member)

Table 2.1.4 Income from services provided under any other contract, agreement or arrangement

Name of occupation (if relevant) and a description of services provided	Name and address of parties to any contract, agreement or arrangement to provide services	Nature of business carried on by the other party to the contract, agreement or arrangement (where the services provided relate to your position as a Member)

2.2 Income from a trust

2.3 Other income

Part 3 Gifts

Part 4 Contributions to travel

Part 5 Interests and positions in corporations

Part 6 Positions in trade unions and professional or business associations

Part 7 Debts

Part 8 Dispositions of property

Part 9 Client services

Part 10 Discretionary disclosures

Form 4 - Discretionary return

(Clause 3 (1), definition of “discretionary return”)

Discretionary return

Constitution (Disclosures by Members) Regulation 1983

Discretionary return

Discretionary Return-Legislative *Council/*Assembly

Note:

1 If a Member considers it appropriate to do so, a Member may make any disclosures in a discretionary return concerning any or all of the matters that a Member is required or permitted to disclose under the Constitution (Disclosures by Members) Regulation 1983 in an ordinary return, before the date on which the Member is next required to lodge an ordinary return or supplementary ordinary return.

2 The particulars required to complete this form are to be written in block letters or typed.

3 If any space is insufficient in this form for all the particulars required to complete it, attach an appendix for that purpose which is properly identified and signed by the Member.

4 Matter marked with an asterisk (*) is to be omitted if it is not appropriate for the Member concerned.

Disclosures of pecuniary interests and other matters by:

(full name of Member)