Financial Conflict of Interest Disclosure Form

Employee Information

Name:
Date:
Position:
Date of Disclosure:

Financial Interests

Please disclose any financial interests that may constitute a conflict of interest with your role at [Your Company Name].

Investments:
Business Interests:
External Employment:
Real Estate Holdings:

Relationships with External Entities

Please disclose any relationships with external entities that may give rise to a financial conflict of interest.

Business Relationships:
Professional Relationships:

Certification and Agreement

I, [Employee Name], hereby certify that the information provided in this Financial Conflict of Interest Disclosure Form is accurate and complete to the best of my knowledge. I understand the importance of disclosing potential conflicts of interest to ensure transparency and ethical conduct in my role at [Your Company Name].

Employee Signature: __________________________

Date: ___________________________