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Dispensation Request

(Please print this form, complete all sections and submit to the Clerk)

I request a dispensation to enable me to discuss the following item on the agenda:


Description and the nature of the disclosable pecuniary interest or other interest (refer to Code of Conduct for examples):


Whether the dispensation is required to participate at a meeting in a discussion only or a discussion and a vote:

Delete as necessary:      Discussion / Discussion and a vote


The date of the meeting or the period (not exceeding four years) for which the dispensation is sought:


An explanation as to why the dispensation is sought (considerations may include: without the dispensation the number of persons prohibited from participating in the particular business would be so great a proportion of the meeting transacting the business as to impede the transaction of the business / granting the dispensation is in the interests of persons living in the Council’s area / it is otherwise appropriate to grant a dispensation.) :


Signed _________________________   Printed __________________________

Date   _________________________


Standing Orders: 4.5.  Dispensation requests shall be in writing and submitted to the Clerk as soon as possible before the meeting, or failing that, at the start of the meeting for which the dispensation is required.