Please enable JavaScript in your browser to complete this form.Name *FirstLastRole *Type of role *VolunteerEmployeeI declare that I hold the following personal and/or pecuniary interest(s): Pecuniary interests are business interests (eg employment) and wider financial interests (eg investments, assets).Current EmploymentBusinesses (of which I am a partner or sole proprietor) Company directorships – details of all companies of which I am a director Charity trusteeships – details of all companies of which I am a trustee Membership of professional bodies, membership organisations, public bodies or special interest groups of which I am a member and have a position of general control or management Gifts or hospitality offered to you by external bodies while acting in your position as an employee/trustee and whether this was declined or accepted in the last 12 months Contracts offered by you for the supply of goods and/or services to the charity Any other pecuniary conflict Please state below any personal conflicts of interestState their name, their relationship to you, the organisation, and the nature of the interestImmediate family/close connections to employee/trustee Company directorships or trusteeships of family/close connections to employee/trustee If you are an employee or trustee of any other organisations with whom a conflict of interest is possible, please provide details below: Please state the name of the organisation, the position held, the date you were appointed/elected to the post, and if appropriate the date of termination of the postTo the best of my knowledge the information supplied above is correct and complete. I understand that it is my responsibility to declare any conflict of interest/loyalty, business or personal that relates directly or indirectly, to myself or any relation in any contract, proposed contract or other matter when present at a meeting at the charity where such contract or matter comes under consideration. I understand that I must withdraw from any meeting during the discussion of such contract or matter and must not vote in respect of it. I agree to review and update this declaration annually and give consent for the information provided to be used in accordance with the charity’s conflicts of interest policy. Signature *Clear SignatureDate of disclosure *Submit Share this:TweetWhatsAppEmailPrintLike this:Like Loading...
