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Health & Safety Services

Personal Declaration Form

In accordance with University Financial Procedure 1 ‘Conflicts of Interest Policy & Procedures’ (FP1) this form must be completed annually by every member of staff, full or part-time, of level 6 and above and everyone involved in the purchasing process or in a financial role. Please note 'Nil' returns are required.

Please also read the HR Personal Conflicts of Interest Policy before completing this form.

All staff, of all levels, must update this document as soon as they become aware of a potential conflict or anything that could be perceived to be a conflict.

Personal Information

Section 1

Have you, at any time over the last twelve months, occupied a position of Director, Partner, Consultant, Trustee, Trader or Employee of any external organisation (including Statutory Authorities) or had any other external appointment (e.g. as a Committee member)? *
If the appointment is on-going tick here and leave date blank:
To the best of your knowledge does the University transact with the above organisation?
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Section 2

Have you, at any time over the last twelve months, held any other paid outside work and/or other significant financial interests (e.g. shareholding), as defined in Section 1.5(a) of FP1? *

Section 3

Have you disclosed all gifts or hospitality received during the last twelve months to your Head of Department, as defined in Sections 1.7 and 1.8 of FP1? *

Section 4

To the best of your knowledge, have any ‘related parties’, (e.g. family members, friends or other associates) as defined in Section 1.2 of FP1, held positions, appointments or significant financial interests or received gifts or hospitality which could create a conflict of interest? *

Section 5

Please read the HR Personal Conflicts of Interest Policy and then indicate below that you have read the policy and taken any necessary action. This policy provides guidance on areas where an interest or relationship may conflict, or appear to conflict, with an individual’s role, duties or responsibilities at Warwick. The policy is to ensure that individuals do not commit acts of impropriety, bias, abuse of authority, favouritism, or leave themselves open to allegations that they have done so. *

Section 6

Are there any other conflicts, or potential conflicts, which you need to disclose in order to comply with the Conflicts of Interest Policy (FP1)? *

Section 7

I confirm that I have read and understood the Conflicts of Interest Policy (FP1) and that based on this policy the information given in this form is to the best of my knowledge true and accurate in all respects. *
*If you would like to retain a copy of the completed document please press PRINT on the tool bar before selecting the 'SEND FORM' button.*
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