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THE INTEGRITY COMMISSION ACT Statutory Declaration of Assets, Liabilities and Income of Parliamentarians and Public Officials Declaration of assets and liabilities at……………31/12/2018…………… (Declaration Date) and of income for the period of twelve months (or other period where appropriate) ending on that date. NOTE: (a) Where any property is held by the declarant, declarant’s spouse or the declarant’s child or children in trust for any other person, this should be indicated by a note to that effect. (b) The declaration date should be the date as at which pursuant to section 41 the declaration is to be made. (c) Where the space in this form is inadequate a separate sheet of paper may be used and signed by the declarant. Name of Declarant JOHN ANTHONY BROWN Name of Declarant’s Spouse LORNA MARIE BROWN Address of Declarant 1 SPECIMEN STREET KINGSTON 4 Address of Declarant’s Spouse 1 SPECIMEN STREET KINGSTON 4 Number of Full Years employment of Declarant 14 Number of Full Years employment of Spouse 10 Taxpayer Registration Number (TRN) of Declarant 111000222 Taxpayer Registration Number (TRN) of Spouse 122000111 Declarant’s Employer – POLICE DEPARTMENT TRAFFIC DIVISION – 16 LWR. ELLETSON ROAD, KINGSTON Maiden Name (of Spouse) GREEN

Integrity Commission - Sample Statutory Declaration Formcpcpd.gov.jm/sites/default/files/pdf/Sample FORM A, Statutory... · 7+( ,17(*5,7< &200,66,21 $&7 6wdwxwru\ 'hfodudwlrq ri $vvhwv

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Page 1: Integrity Commission - Sample Statutory Declaration Formcpcpd.gov.jm/sites/default/files/pdf/Sample FORM A, Statutory... · 7+( ,17(*5,7< &200,66,21 $&7 6wdwxwru\ 'hfodudwlrq ri $vvhwv

THE INTEGRITY COMMISSION ACT

Statutory Declaration of Assets, Liabilities and Income

of Parliamentarians and Public Officials

Declaration of assets and liabilities at……………31/12/2018…………… (Declaration Date) and of income for the period of twelve months (or other period where appropriate) ending on that date. NOTE:

(a) Where any property is held by the declarant, declarant’s spouse or the declarant’s child or children in trust for any other person, this should be indicated by a note to that effect.

(b) The declaration date should be the date as at which pursuant to section 41 the

declaration is to be made.

(c) Where the space in this form is inadequate a separate sheet of paper may be used and signed by the declarant.

Name of Declarant JOHN ANTHONY BROWN

Name of Declarant’s Spouse LORNA MARIE BROWN

Address of Declarant 1 SPECIMEN STREET KINGSTON 4

Address of Declarant’s Spouse 1 SPECIMEN STREET KINGSTON 4

Number of Full Years employment of Declarant 14

Number of Full Years employment of Spouse

10 Taxpayer Registration Number (TRN) of Declarant

111000222 Taxpayer Registration Number (TRN) of Spouse

122000111 Declarant’s Employer – POLICE DEPARTMENT TRAFFIC DIVISION – 16 LWR. ELLETSON ROAD, KINGSTON

Maiden Name (of Spouse) GREEN

Page 2: Integrity Commission - Sample Statutory Declaration Formcpcpd.gov.jm/sites/default/files/pdf/Sample FORM A, Statutory... · 7+( ,17(*5,7< &200,66,21 $&7 6wdwxwru\ 'hfodudwlrq ri $vvhwv

PARTICULAR OF DECLARANT’S CHILDREN

Names Date of Birth Addresses

DEVON BROWN 10/01/1999 5 STEPHENSON STREET, KINGSTON 20

DENISE BROWN 11/02/2004 1 SPECIMEN STREET, KINGSTON 4

DORETT BROWN 12/03/2009 1 SPECIMEN STREET, KINGSTON 4

J. Brown

Signature of Declarant

PARTICULARS OF ASSETS HELD BY DECLARANT, SPOUSE AND CHILDREN BANK ACCOUNTS

1. TO BE SUPPORTED BY BANK STATEMENT OR LETTER FROM BANK CONFIRMING BALANCES.

Name and Address of Banks In Whose Name Held Balance in Account

NATIONAL COMMERCIAL BANK 54 KING STREET, KINGSTON

JOHN BROWN

217,531.60

BANK OF NOVA SCOTIA 80 HALF WAY TREE ROAD, KINGSTON 10

JOHN & LORNA BROWN

85,311.22

NATIONAL COMMERCIAL BANK 94 HALF WAY TREE ROAD, KINGSTON 10

DENISE BROWN

28,521.64

JAMAICA POLICE COOPERATIVE CREDIT UNION LIMITED 20 HARBOUR STREET KINGSTON

JOHN BROWN

502,224.00

AAMM CO-OPERATIVE CREDIT UNION LIMITED 10 OXFORD TERRACE, KINGSTON 5

LORNA BROWN

44,332.00

J. Brown Signature of Declarant

Page 3: Integrity Commission - Sample Statutory Declaration Formcpcpd.gov.jm/sites/default/files/pdf/Sample FORM A, Statutory... · 7+( ,17(*5,7< &200,66,21 $&7 6wdwxwru\ 'hfodudwlrq ri $vvhwv

2. CASH IN EXCESS OF FIVE HUNDRED THOUSAND DOLLARS HELD

OTHER THAN IN BANK BY DECLARANT, SPOUSE AND CHILDREN.

Where Held In Whose Name Held Amount

PAY-FORWARD LOOM – ADASSA BROWN (BANKER)

John Brown 600,000.00

J. Brown

Signature of Declarant

3. BONDS, STOCKS, SHARES AND SIMILAR INVESTMENTS INCLUDING

ANY SUCH PROPERTY OVER WHICH A RIGHT OF DISPOSITION RESIDES IN THE DECLARANT, SPOUSE AND CHILDREN.

No. and

Description Organization

in Which being Held

In Whose Name Held

Face Value Cost of Acquisition Where Known or

Market Value 1,000 ORDINARY SHARES

JAMAICA MONEY MARKET BROKERS LIMITED

JOHN BROWN

$100,000.00

$500,000.00 (C)

J. Brown

Signature of Declarant

Page 4: Integrity Commission - Sample Statutory Declaration Formcpcpd.gov.jm/sites/default/files/pdf/Sample FORM A, Statutory... · 7+( ,17(*5,7< &200,66,21 $&7 6wdwxwru\ 'hfodudwlrq ri $vvhwv

4. IMMOVABLE PROPERTY (e.g. HOUSE, LAND AND FARM BUILDINGS)

HELD BY DECLARANT, SPOUSE AND CHILDREN

. J. Brown

Signature of Declarant 5. MONIES INVESTED IN MORTGAGES OR BUSINESS VENTURES (INCLUDING

CROPS AND LIVESTOCK) BY DECLARANT, SPOUSE AND CHILDREN. Type of

Investment In Whose

Name Held

Amount Invested

in Project

Term Interest Rate

Annual Income

Three Cows John & Adolphus Brown

150,000 - - -

J. Brown

Signature of Declarant

Description

Where Situated

Date of Acqui-sition

In

Whose Name Held

Purchase

Price

Estimated Current Market Value

General Vol. Fol.

DWELLING HOUSE

1234 987 1 SPECIMEN STREET, KINGSTON

JOHN & LORNA BROWN

$600,000 $12,500,000

Page 5: Integrity Commission - Sample Statutory Declaration Formcpcpd.gov.jm/sites/default/files/pdf/Sample FORM A, Statutory... · 7+( ,17(*5,7< &200,66,21 $&7 6wdwxwru\ 'hfodudwlrq ri $vvhwv

6. PARTICULARS OF MOTOR VEHICLES OWNED BY, OR ON HIRE

FOR ANY PERIOD TO, OR ON LOAN FOR A PERIOD IN EXCESS OF TWO MONTHS TO THE DECLARANT, SPOUSE OR CHILDREN.

Description Owner’s Name

Age of Vehicle

Terms of Hireage

(if Hired)

Purchase Price

2018 MITSUBISHI ASX

JOHN BROWN

1 - $3,830,000.00

2012 TOYOTA COROLLA

LORNA BROWN

6 $2,000,000.00

J. Brown

Signature of Declarant

7. VALUES HELD IN SAFETY DEPOSIT BOXES BY DECLARANT, SPOUSE AND CHILDREN

Where Held Owner’s Name

Contents Purchase Price

Market Value

NCB 94 Half-Way-Tree Rd

Beverly Johnson & Lorna Brown

Jewellery Unknown - inherited

$350,000.00 (approx)

J. Brown

Signature of Declarant

Page 6: Integrity Commission - Sample Statutory Declaration Formcpcpd.gov.jm/sites/default/files/pdf/Sample FORM A, Statutory... · 7+( ,17(*5,7< &200,66,21 $&7 6wdwxwru\ 'hfodudwlrq ri $vvhwv

8. INSURANCE POLICIES HELD BY DECLARANT, SPOUSE AND CHILDREN.

Insurance Company

Type of Policy

Date Issued

Date of Maturity

Name of Insured

Annual Premium

Face Value

Surrender Value

SAGICOR INVEST-MENT

01/06/99 31/05/21 JOHN BROWN

$16,000 $5,000,000 $63,450

SAGICOR INVEST-MENT

01/01/04 31/12/23 LORNA BROWN

$10,720 $4,000,000 $28,760

J. Brown

Signature of Declarant

9. ANY OTHER PROPERTY OWNED BY DECLARANT, SPOUSE

AND CHILDREN.

Description Owner’s Name

By Whom Being Held

In What capacity

being Held

Estimated Market Value

30 Ft Fishing Canoe Adolphus & John Brown

Adolphus Brown

Part owner and operator

$170,000.00

6 Paintings Adolphus Brown

Adolphus Brown

Owner $350,000.00

J. Brown Signature of Declarant

Page 7: Integrity Commission - Sample Statutory Declaration Formcpcpd.gov.jm/sites/default/files/pdf/Sample FORM A, Statutory... · 7+( ,17(*5,7< &200,66,21 $&7 6wdwxwru\ 'hfodudwlrq ri $vvhwv

10. OTHER PROPERTY OWNED BY DECLARANT, SPOUSE AND

CHILDREN, BEING HELD BY A PERSON OTHER THAN OWNER, WHETHER IN TRUST OR OTHERWISE.

Description Owner’s

Name By Whom Being Held

In What Capacity

Being Held

Estimated Market Value

Trust/College Funds

Denise & Dorret Brown

Barita Investments/ Foster & Co.

Trustees nominated by Beverly Johnson

$2,200,000

J. Brown

Signature of Declarant

11. PARTICULARS OF INCOME FROM ALL SOURCES, OF DECLARANT, SPOUSE AND CHILDREN (INCLUDING PERQUISITES SUCH

AS HOUSE, ENTERTAINMENT, ALLOWANCES, RENTALS, ETC.)

Type of Income Recipient’s Name Source Gross Amount for Period under

Review

SALARY JOHN BROWN EMPLOYMENT $4,525,000.00

TRAVELING JOHN BROWN EMPLOYMENT $813,564.00

SALARY LORNA BROWN EMPLOYMENT $2,425,000.00

J. Brown

Signature of Declarant

Page 8: Integrity Commission - Sample Statutory Declaration Formcpcpd.gov.jm/sites/default/files/pdf/Sample FORM A, Statutory... · 7+( ,17(*5,7< &200,66,21 $&7 6wdwxwru\ 'hfodudwlrq ri $vvhwv

12. PARTICULARS OF LIABILITIES (INCLUDING GUARANTEES) OF

DECLARANT, SPOUSE AND CHILDREN. Certificate from creditor or party to which guarantee given, should be provided.

Nature of Liability Person Liable To Whom Liable Amount

MORTGAGE JOHN & LORNA BROWN

NATIONAL HOUSING TRUST

$6,000,000.00

MOTOR CAR LOAN JOHN BROWN JAMAICA POLICE CO-OPERATIVE CREDIT UNION LIMITED

$3,000,000.00

Guarantor: Student Loan John Brown STUDENT LOAN BUREAU

$500,000.00

Credit – Building Material

John & Lorna Brown Tools Hardware $482,000.00

J. Brown

Signature of Declarant

13. PARTICULARS OF ANY PROPERTY ACQUIRED OR DISPOSED OF BY DECLARANT, SPOUSE AND CHILDREN (DURING PERIOD OF

12 MONTHS OR OTHER PERIOD WHERE APPROPRIATE) ENDING ON…………31/12/2018……………………

Description of Property Acquisition or

Disposal Cost of

Acquisition Price of Disposal

2018 MITSUBISHI ASX MOTOR CAR ACQUISITION $3,830,000.00 -

2010 TOYOTA COROLLA MOTOR CAR

DISPOSAL - $1,100,000.00

I do solemnly and sincerely declare that the particulars given by me herein are, to the best of

my knowledge, true, accurate and complete.

J. Brown

Signature of Declarant Signed at………45-47 Barbados Ave, Kingston 5……..

this 3rd day of……January 2019…….before............ Signature of any J.P. Justice of the Peace for the Parish

of ……Any Parish…..

Page 9: Integrity Commission - Sample Statutory Declaration Formcpcpd.gov.jm/sites/default/files/pdf/Sample FORM A, Statutory... · 7+( ,17(*5,7< &200,66,21 $&7 6wdwxwru\ 'hfodudwlrq ri $vvhwv

14. PARTICULARS OF ANY GIFT

Description of Gift/Nature

Name and Address of Donor

Approximate Value of Gift

Building material including: 3 truckloads of sand and marl

Carlton Brown South Course Quarry and Mines 10 Backtu Road, Clarendon

$150,000

J. Brown

Signature of Declarant 15. PARTICULARS OF DEBT FORGIVENESS

Description of Property

Amount of Debt

Forgiveness

By Whom Debt Forgiven

Outstanding loan on 2010 Toyota Corolla

$250,000.00 World Adventure Lending Services

J. Brown

Signature of Declarant

OFFICIAL RECEIPT Received from …………………….…..………… Statutory Declaration for the period Declarant’s Name

……….……………………….. ...……………...…....... Signature

.................……………. Date

Page 10: Integrity Commission - Sample Statutory Declaration Formcpcpd.gov.jm/sites/default/files/pdf/Sample FORM A, Statutory... · 7+( ,17(*5,7< &200,66,21 $&7 6wdwxwru\ 'hfodudwlrq ri $vvhwv
Page 11: Integrity Commission - Sample Statutory Declaration Formcpcpd.gov.jm/sites/default/files/pdf/Sample FORM A, Statutory... · 7+( ,17(*5,7< &200,66,21 $&7 6wdwxwru\ 'hfodudwlrq ri $vvhwv
Page 12: Integrity Commission - Sample Statutory Declaration Formcpcpd.gov.jm/sites/default/files/pdf/Sample FORM A, Statutory... · 7+( ,17(*5,7< &200,66,21 $&7 6wdwxwru\ 'hfodudwlrq ri $vvhwv