Form of Statement of Registrable Interestsfor Completion in Accordance with Section 5 of the Ethics in Public Office Acts 1995

(as amended by the Standards in Public Office Act 2001)

Registration Period covered by this statement: 1 January to 31 December 2012.

Members may find it convenient (and it will greatly facilitate the preparation of the register of interests) to complete this form electronically and return it by e-mail to

However an original copy of that form, duly signed, must also be submitted to the Standards in Public Office Commission (or in the case of a nil return, to the Clerk of the Dáil) by 31 January 2013.

Guidelines for Members of Dáil Éireann 2012