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Application forregistration as a charity

Trustee Declaration

Goldclass Green Projects

Application Number: 5015749

Submission Date:  18 January 2011

Each person who signs below declares that he/she is:

b Willing to act as a charity trustee and is fully aware of the organisation's object(s) andother provisions set out in the governing document;

b Not disqualified from acting as a charity trustee of any charity because of sections 72and 73 of the Charities Act 1993;

b Not disqualified and/or barred from acting as a trustee of this particular charity underthe provisions of the Safeguarding Vulnerable Groups Act 2006 which deal with peoplewho are working in a regulated and/or controlled activity.

They also jointly and individually declare that:

b the funds of the organisation are, or will immediately upon registration as a charity, beheld in an account in the name of the charity;

b the information contained on the application form and this trustee declaration form istrue, complete and correct; and

b they understand that the information in this declaration will be used by the Commissionin discharging its statutory purpose and that knowingly making a false or misleadingstatement is a criminal offence under section 11 of the Charities Act 1993; and

b they are aware of their responsibilities as trustees and have read the Commission'sguidance "The Essential Trustee: What you need to know (CC3)".

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Working with vulnerable people

Working with childrenYou must complete this part of the declaration. The decision as to which box needs to beticked must reflect the responses you have made to the questions in the Vulnerable People -Working with Children section of the online application.

To avoid confusion mark the appropriate box with a tick(not a cross)

A We jointly declare that we have ensured that CRBchecks have been obtained on all trustees and that weare satisfied that all the trustees are suitable to act astrustees of a charity which works with children.

B We jointly declare that we are not required by law tocarry out CRB checks on the trustees and also that weare not allowed by law to carry out such checks.

C We jointly declare that we are satisfied that thesafeguards referred to in the Vulnerable People -Working with Children section of the application forregistration are adequate to ensure that an unsuitableindividual does not have access to any children withwhom the charity works.

Working with vulnerable adultsYou must complete this part of the declaration. The decision as to which box needs to beticked must reflect the responses you have made to the questions in the Vulnerable People -Working with Vulnerable Adults section of the online application.

To avoid confusion mark the appropriate box with a tick(not a cross)

D We jointly declare that we have ensured that CRBchecks have been obtained on all trustees and that weare satisfied that all the trustees are suitable to act astrustees of a charity which works with vulnerableadults.

E We jointly declare that we are not required by law tocarry out CRB checks on the trustees and also that weare not allowed by law to carry out such checks.

F We jointly declare that we are satisfied that thesafeguards referred to in the Vulnerable People -Working with Vulnerable Adults section of theapplication for registration are adequate to ensure thatan unsuitable individual does not have access to anyvulnerable adults with whom the charity works.

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Trustee Declaration

Goldclass Green Projects

Application Number: 5015749

Private BenefitWe jointly and individually declare that we are satisfied that any private benefits received byany person, connected or otherwise:

b directly contribute towards achieving the organistation's purposes and are a necessaryresult of carrying out those purposes; or

b are a necessary by-product of carrying out those purposes; and

b in either case, are not excessive in the circumstances.

Total number of trustees 1

Trustee Name Signature Date

Print name here ...

on behalf of GoldclassHealthcare Ltd