Conflict of Interest Declaration

{{company_name}}

{{company_address}}

Phone: {{phone}} | Email: {{email}} | Web: {{website}}

Conflict of Interest Declaration

Conflict of Interest Declaration

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

CONFLICT OF INTEREST DECLARATION FORM

**Date:** {{date}}

**Employee Name:** {{employee_name}}

**Employee ID:** {{employee_id}}

**Department:** {{department}}

This form is to be completed by all employees to declare any potential or actual conflicts of interest. A conflict of interest arises when an employee's personal interests (or the interests of a close family member or associate) could, or could be perceived to, improperly influence the employee's judgment or actions in the performance of their duties.

1. Declaration of Personal Interests

Do you, or does a close family member (spouse, partner, child, parent, sibling), have a significant financial interest (e.g., shares, directorship, significant ownership) in any organisation that currently does business with, competes with, or is seeking to do business with {{company_name}}?

**Yes/No:** {{financial_interest_yn}}

If yes, please provide details:

{{financial_interest_details}}

2. Declaration of External Activities

Are you, or is a close family member, engaged in any external employment, business, or professional activity that could conflict with your duties and responsibilities at {{company_name}}?

**Yes/No:** {{external_activity_yn}}

If yes, please provide details:

{{external_activity_details}}

3. Gifts, Entertainment, and Hospitality

Have you received any gifts, entertainment, or hospitality from any external party (e.g., clients, suppliers, competitors) that could be perceived as influencing your professional judgment, and which falls outside the company's established policy on gifts and hospitality?

**Yes/No:** {{gifts_entertainment_yn}}

If yes, please provide details:

{{gifts_entertainment_details}}

4. Use of Company Information or Assets

Have you used, or do you intend to use, company confidential information, property, or assets for personal gain or for the benefit of any external party?

**Yes/No:** {{company_info_assets_yn}}

If yes, please provide details:

{{company_info_assets_details}}

5. Relationships with External Parties

Do you have any personal relationships (e.g., dating, close friendship) with individuals employed by or associated with organisations that currently do business with, compete with, or are seeking to do business with {{company_name}}?

**Yes/No:** {{external_relationships_yn}}

If yes, please provide details:

{{external_relationships_details}}

6. Previous Disclosures

Have you previously disclosed any potential conflicts of interest to the company that are still relevant?

**Yes/No:** {{previous_disclosures_yn}}

If yes, please refer to the date and nature of the previous disclosure:

{{previous_disclosures_details}}

7. Declaration and Acknowledgment

I hereby declare that the information provided above is true, complete, and accurate to the best of my knowledge and belief. I understand that failure to disclose a conflict of interest, or providing false or misleading information, may result in disciplinary action, up to and including termination of employment.

I acknowledge that I have read and understood {{company_name}}'s Conflict of Interest Policy and agree to abide by its terms. I undertake to inform {{company_name}} promptly of any changes in my circumstances that could give rise to a conflict of interest.

I also understand that {{company_name}} reserves the right to investigate any declared or potential conflict of interest and to take appropriate action to manage or resolve such conflicts.

Signature Block

**Employee Signature:** _________________________ **Date:** _________________________

**Printed Name:** _________________________

**Reviewed by (HR/Management):** _________________________ **Date:** _________________________

**Printed Name:** _________________________

**Position:** _________________________

**Action Taken (if any):** {{action_taken}}