Declaration for YI Officers

If you are unable to sign any part of the declaration, or if in ANY DOUBT, strike out the relevant section(s) and supply full details on the back of this form. Your appointment will be subject to approval by the YI National Council. All information supplied will be treated in the strictest of confidence.

I declare that:

1: I am currently not a member of any other political party.

2: I have never engaged in, advocated or condoned racist, violent, criminal or anti-democratic activity.

3: I have never been a member of or had links with any organisation, group or association which the National Executive Committee considers is liable to bring the party into disrepute.

4: I have never been convicted of any offence punishable by a custodial sentence, whether or not a custodial sentence was actually imposed.

5: I do not have any ‘skeletons in the cupboard’ that may cause me or UKIP embarrassment if they were to come out during the election.

6: I shall notify the YI Chairman immediately upon being interviewed under caution (i.e. as a suspect in a criminal case) and upon becoming subject to any legal proceedings in this country or abroad during my time as a candidate/elected member.

7: All media I do for YI will be confirmed with the YI Media Officer first

8: Complete the minimum requirements of the role as laid out by the ‘How YI Works?’ document or risk disciplinary from the national council

9: I will abide by all laws and Party rules relating to the use of Party information and data.

10: I will abide by any decisions made by the YI Council throughout my term.

11: Are you/have you ever been a member of the BNP, EDL, or any other organisation that might be of public interest? Y/N if yes give details:

12: Please declare any social media you are using, facebook, twitter, blogs etc and your usernames. This question has been introduced to avoid embarrassment to UKIP and to individual candidates who may have not realised their vulnerability to past indiscretions in social media or other public forums. Its completion is entirely voluntary but we expect every candidate to complete it and to be honest and frank with their answers. It will be used to check public forums.

13: Do you have a Facebook account y/n

YI Declaration Form August 2014 – January 2018 If Y what is the URL of your profile page? ______

Do you have more than one profile or page. If so what are they? ______

______

14: Do you have a Twitter account y/n

If Y what name do you use? @______

Do you have more than one account. If so what are they? ______

______

15: Do you contribute to any blogs or forums? If so what names/emails do you use?

______

______

16: Are there any public comments or actions you might have made in the past that could be used to embarrass you or UKIP? If yes please detail them below or ask to speak to an officer.

______

17: I confirm that the statements made in this application are, to the best of my knowledge, accurate. I authorise UKIP to make such further confidential enquires relating to this application as it considers necessary.

Full Name: ______

Address: ______

______

Mobile phone number: ______

Email address: ______

UKIP Membership number: ______

Signature: ______

YI Position: ______

Date:______

YI Declaration Form August 2014 – January 2018