Conflicts of Interest Questionnaire

I have read the organization’s Conflict of Interest Policy and in signing this certificate, I have considered not only the literal expression of the Policy, but also its intent. I hereby certify that, except as hereinafter stated, I do not, to the best of my knowledge, have any relations or interests whatever conflicting with the interests of the organization.

The exceptions are:

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

I have business relationships with the following board members:

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

If any situation should arise in the future which I think may involve me in a conflict of interest, I will promptly and fully disclose the circumstances to the top leader or the board chair.

Furthermore, I agree to abide by the statement of confidentiality as contained in the foregoing organization Conflict of Interest Policy.

 

Printed Name _______________________________________________________

Signed_____________________________________________________________    Date___________________

 


This text is provided with the understanding that ECFA is not rendering legal, accounting, or other professional advice or service. Professional advice on specific issues should be sought from an accountant, lawyer, or other professional.

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