Conflict of Interest Declaration

This form requires individuals to disclose details of any and all interests that are relevant that may be in conflict with their duties and responsibilities in the course of their duty.

We must understand the risks of organisational and personal conflicts of interest, what situations to avoid and why they should be avoided. This allows us to make sound decisions and ensure that those involved can remain impartial and do what is right.

A conflict of interest may arise when personal interests, activities or relationships affect an individual's ability to be impartial and act in the best interest of Football Victoria.

When a conflict of interest is identified whether that be potential, percieved or real inform Football Victoria immediately.

Please fill out this form as a declaration that no conflict of interest exists in your position and if they do provide details on what they may be so that they are assessed and we can assist in prevention.

Name

First NameLast Name

Phone Number

Please enter a valid phone number.

Email

example@example.com

Is there a conflict of interest to declare?*

Yes (please provide further details below)No

I hereby declare to the best of my knowledge that I:

Do have any actual, potential or perceived personal interest in any matters related to my role with Football Victoria which could affect my ability to act impartial in the best interests.Do have any friends, family members, business partners or other acquaintances who have a personal interest in any matters related to my role with Football Victoria which could affect my ability to act impartial and in the best interests.

Please provide details of conflict, any mitigating circumstances etc.

I hereby declare that I fully understand that in case any information that may cause me to be in a position that shall be a conflict of interest with regard to my duties and responsibilities arises after this declaration, I shall thereafter inform Football Victoria.

I shall abide by the rules and regulations set forth by the institution, including any relevant rules and regulations, with regard to conflict(s) of interest.

I hereby declare that I make this conflict of interest declaration with the above details being true and correct to the best of my knowledge and in good faith.

Date signed

Date

Signature