This template is a declaration for Responsible People that confirms that they are not disqualified under Governance Standard 4.
I, [name], of [address], declare that:
- I am not disqualified from managing a corporation, within the meaning of the Corporations Act 2001 (Cth), and
- I have not been disqualified by the Australian Charities and Not-for-profits Commissioner at any time during the previous year from being a Responsible Person (what the ACNC Act calls a ‘responsible entity’) of a registered charity.
While I am a Responsible Person for [charity name], I agree to notify this charity as soon as possible if I do become disqualified from managing a corporation within the meaning of the Corporations Act 2001, or am disqualified by the Australian Charities and Not-for-profits Commissioner. Responsible People are the members of a charity’s governing body who share responsibility for the governance of the charity (called ‘responsible entities’ under the ACNC Act).
Declared at: [location]
On: [date]
Signature:
Name:
Position: