The Conflict Of Interest Form Template – Australia is offered in multiple formats, including PDF, Word, and Google Docs. These formats are designed to be both editable and printable, ensuring you can easily customize and utilize them as needed.
Conflict Of Interest Form Template – Australia Editable | PrintableSample
1. Parties Involved 2. Description of Potential Conflict of Interest 3. Nature of Relationship 4. Disclosure of Financial Interests 5. Steps Taken to Mitigate Conflict 6. Acknowledgment of Policy 7. Review and Approval 8. Signature and Date
PDF
WORD
Examples
[Employee’s Name]
[Employee’s ID]
[Department]
[Position]
[Contact Information]
This form aims to disclose any potential or actual conflicts of interest that may arise in relation to the employee’s role within the organization, to ensure transparency and maintain ethical standards.
Employees are required to complete this form to declare any personal, financial, or professional interests that could influence, or appear to influence, their judgment in carrying out their duties.
Please list any financial interests, direct or indirect, in any business or organization that may potentially conflict with your responsibilities to the company:
[Describe Interests]
Identify any relationships with clients, suppliers, or competitors that could create potential conflicts:
[Describe Relationships]
Please disclose any other potential conflicts that may arise due to external affiliations, volunteer roles, or personal interests that relate to your position:
[Describe Other Conflicts]
I acknowledge that I have read and understand the company’s policy regarding conflicts of interest. I confirm that the above disclosures are true and complete to the best of my knowledge.
[Employee’s Signature]
[Date]
[Management Review and Comments]
[Employee’s Name]
[Employee’s ID]
[Department]
[Position]
[Contact Information]
This form serves to identify and disclose any actual or perceived conflicts of interest that could influence decision-making and ethical obligations within the company.
Employees must submit this form whenever new potential conflicts arise or annually as part of the compliance process.
Please list all financial interests that may conflict with your duties to the organization:
[Describe Interests]
Disclose any significant relationships outside the organization that may affect your role:
[Describe External Relationships]
If you have any outside employment that could create a conflict, please provide details:
[Describe Outside Employment]
I declare that the information provided is accurate. I understand the implications of any conflicts disclosed and the necessity of addressing them promptly.
[Employee’s Signature]
[Date]
[Management Comments and Action Taken]
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