CoI Review

CoI Review

#	Employee	Type	Status	Date Submitted By
#	Employee	Type	Status	Date Submitted By

#	Employee	Type	Status	Date Submitted By
#	Employee	Type	Status	Date Submitted By

#	Employee	Type	Status	Date Submitted By
#	Employee	Type	Status	Date Submitted By

Select User *

Select Approving Officer.

#	Employee	Type	Status	Date Submitted By
#	Employee	Type	Status	Date Submitted By

Type *

Enter Type.

Disclosure Checklist

To the best of my knowledge and belief any actual, perceived or potential conflicts between my duties as an employee and my private and/or business interests have been fully disclosed in this form in accordance with the requirements of the company's Conflict of Interest Policy.

I acknowledge, and agree to comply with, any approach identified in this form for removing or managing an actual, perceived or potential Conflict of Interest.

No. I do not have any Conflict of Interest

Yes, I believe I have a potential, perceived and/or actual Conflict of Interest