Conflict of Interest Declaration
Staff Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Declaration A
No conflicts of interest
Declaration A (if no conflicts of interest)By signing this Form, I declare that I have read and accept the conflict of interest policy, and that there are no conflicts of interest of any nature which would prevent me from participating in End point assessment If any actual, potential or perceived conflicts of interest arise in the future, I will inform an Authorised Individual immediately Signature
Declaration B
I do have conflicts of interest
Declaration B (I do have conflicts of interest) that i need to let you know about they are listed below
Signature
Submit
Should be Empty: