If NO for all answers, please date and sign (or add name if sending by NHS email) the form on page 6 and return to the appropriate recipient as per information on page 6. CURRENT PERSONAL INTERESTS* Name of Company Nature of Interest Is the interest (e.g. shares, fees, consultancy, salary, grants etc.) specific or *Please state if your interest is limited to a particular product or of products NON-PERSONAL INTERESTS have arisen during the last 12 months) Name of Company Nature of Interest Is interest Is the interest current? specific or non-specific? (yes or no)
If NO for all answers, please date and sign (or add name if sending by NHS email) the form on page 6 and return to the appropriate recipient as per information on page 6. CURRENT PERSONAL INTERESTS* Name of Company Nature of Interest (e.g. shares, fees, consultancy, salary, grants etc.) Is the interest specific or *Please state if your interest is limited to a particular product or of products NON-PERSONAL INTERESTS have arisen during the last 12 months) Name of Company Nature of Interest Is interest current? (yes or no) Is the interest specific or non-specific?