IWIRC Annual Certification of Compliance with Conflict of Interest Policy

International Women's Insolvency & Restructuring Confederation (IWIRC) Annual Certification of Compliance with Conflict of Interest Policy
Name

First Name Last Name
IWIRC Position Held
Please describe below any employment relationship (employee, partner, etc.) or any other position you hold (paid or unpaid, volunteer or otherwise) in another entity (whether for profit or non-profit), or circumstances or arrangements that could contribute to a conflict of interest between IWIRC and your personal interests, financial or otherwise (e.g. as a vendor or recipient of funds from IWIRC. If none, please so state.
I hereby certify that:

a.      I have received, read and understand the IWIRC Conflict of Interest Policy and understand my affirmative duty to disclose any potential conflict raised by a financial or other interest in or relationship to an entity other than IWIRC.

b.      I further certify that the information set forth above is true and complete to the best of my knowledge.

d.     I understand that the IWIRC is a U.S. tax-exempt entity and in order to maintain its U.S. federal tax exemption it must engage primarily in activities which accomplish one or more of its tax-exempt purposes.

e.      I certify that I am presently in full compliance with and shall continue to comply with the letter and spirit of the IWIRC Conflict of Interest Policy.
I agree
Signature

Clear
Date

Month Day Year
Date
Should be Empty:

International Women's Insolvency & Restructuring Confederation (IWIRC) Annual Certification of Compliance with Conflict of Interest Policy