Details of Conflict Self Connected Actual Perceived Potential Person/s (name/s) Conflict Conflict Conflict 1. 2. 3. 4. 5. 6. perceived or potential conflict of interest with your insert Club activities? 3. To your knowledge, do you or any connected person have a significant or influential relationship with, or any financial interest in, any organisation with which insert Club has a relationship, financial or otherwise? 4. In the last 2 years have you or any connected person, had any personal dealings with any insert Club existing or known potential sponsor? 5. Are you or any connected person, currently or previously in the last 2 years, a member of another insert sport Club? 6. To your knowledge, do you or any connected person have any other interest that may constitute a conflict of interest? the table below for all questions answered YES. Please complete An Interest is a financial or non-financial interest involving yourself or a Connected Person. A Connected Person is anyone you have (or had) a relationship which is likely to appear to a reasonable person to influence your objectivity including but not limited to close family, partner and close personal friends. I acknowledge that I have read and understood the insert Club policy on Conflict of Interest. I confirm that I have completed the answers to the best of my knowledge and that the information supplied is true and correct. I confirm that I will update insert Club with any changed or new information.
perceived or potential conflict of interest with your insert Club activities? 3. To your knowledge, do you or any connected person have a significant or influential relationship with, or any financial interest in, any organisation with which insert Club has a relationship, financial or otherwise? 4. In the last 2 years have you or any connected person, had any personal dealings with any insert Club existing or known potential sponsor? 5. Are you or any connected person, currently or previously in the last 2 years, a member of another insert sport Club? 6. To your knowledge, do you or any connected person have any other interest that may constitute a conflict of interest? Please complete the table below for all questions answered YES. Details of Conflict Self Connected Person/s (name/s) Actual Conflict Perceived Conflict Potential Conflict 1. 2. 3. 4. 5. 6. An Interest is a financial or non-financial interest involving yourself or a Connected Person. A Connected Person is anyone you have (or had) a relationship which is likely to appear to a reasonable person to influence your objectivity including but not limited to close family, partner and close personal friends. I acknowledge that I have read and understood the insert Club policy on Conflict of Interest. I confirm that I have completed the answers to the best of my knowledge and that the information supplied is true and correct. I confirm that I will update insert Club with any changed or new information.
2016-03-15-35-1-club-conflict-of-interest-poli.docx