Conflict of Interest Declaration
  • About this Declaration
    • Who is employee?
    • Who is employer?
    • Disclosure Details
  • Complete the Document
    • Format & Signatures

Who is employee?

  • Indicate full name of the employee signing this declaration:

  • Provide the employee's current job title or position:

  • Indicate full name of the department in which the employee currently works:

Who is employer?

  • Indicate full name of a business or company to whom this declaration is submitted (Employer):

  • The employer has:

    !

    An ACN is a unique 9-digit number issued by the Australian Securities and Investments Commission to identify a registered company in Australia.

    An ABN is a unique 11-digit number issued by the Australian Business Register to identify a business operating in Australia.

  • Provide the employer's ACN number:

  • Provide the employer's ABN number:

Disclosure Details

  • Select the date on which this declaration is being sent:

  • Describe the essence of the conflict of interest the employee is reporting in this declaration:

  • Do you want to add a signature?

  • Employee's signature:

Select a template's format:

PDF
DOCX
Back
You can skip answers for the questions.
Skipped answers will appear as blank part in the text of the final document. You can fill them in at later stage.
Back
Skip
Next
You can skip answers for the questions.
Skipped answers will appear as blank part in the text of the final document. You can fill them in at later stage.