Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697797305072.pdf (Dominica)
Integrity In Public Office Commission (Integrity in Public Office Act,No.6 of 2003) Form 2 DECLARATION OF INCOME, ASSETS AND LIABILITIES Name of Declarant Office Address Name of Spouse Address of Spouse Names of Children Address of Children 1.

INCOME: Salary and Allowances Fees Commissions Bonus Dividends Gifts received Rents 2.

ASSETS: (a) Real Property Description and value in the opinion...
Location: Rents (state from whether house or land) (b) Cash in Bank (Identify each Bank separately and state amount) (c) Life Insurance Policies (Identify each company separately, state annual premiums, ... (d) Shareholdings in companies and holdings in partnership and joint ventures (List each enterprise separately, ....) (e) Directorships and partnerships (Identify enterprise, nature of its business, date of appointment....) (f) Other Assets Motor Vehicles Boat Government Bonds Other (g) Gifts made in value exceeding one thousand dollars 3.
Liabilities (a) Mortgages (b) Judgement Debts (c) Other Debts Dated this..........day of......................................., 20......
I ...................................................................................................................................................................... Hereby declare that this declaration gives full, true and complete particulars of the assets and liabilities as on the relevant date, that is............................................................and the income during a period of twelve months immediately prior to that date, of myself to the extent to which I have knowledge of the same.
Declarant ..................................................................