Conflict of Interest Questionnaire

Conflict of Interest Questionnaire
This form is an implementation of NetZero’s Conflict of Interest Policy.

The aim is to have transparency on your situation. Answering "Yes" to a question does not necessarily imply wrongdoing.

Unless otherwise indicated, all questions refer to the past 12 months (including today) as well as the foreseeable future.
Note: this form processes personal data. Please refer to NetZero's Privacy Notice for more information.

Family and close relationships within NetZero
IMPORTANT: Family members and close relationships include, at least, your spouse/partner, children, parents, siblings, and their respective spouses
Has any of your family members or close personal relationships been working at NetZero in any capacity?
Please provide details
Have you been employing or supervising them, or holding any decision-making power in their hiring, promotion, or compensation?
Please provide details

Beyond NetZero
Do you hold (or have you held) any other job or professional position in addition to the one you hold with NetZero?
Please provide details
At any point in the past 5 years, have you been holding, or are you aware of any of your family or close relationships holding, any political, administrative, or judicial functions that may be able to influence decisions affecting NetZero?
Please provide details
Have you been serving, or are you aware of any of your family or close relationships serving, as a decision-maker or advisor in any civic organization (charitable, sports, educational, volunteering, or similar) that has been financially supported by NetZero?
Please provide details

Business/financial interests
Do you have, or are you aware of any of your family or close relationships having, any business or employment relationship with a supplier, service provider, distributor, customer or competitor of NetZero, be them current, former, or in tender process?
Please provide details
Do you have, or are you aware of any family or close relationships having, directly or indirectly, any personal financial interest in past, current, or planned business transaction in which NetZero is involved or interested?
Please provide details
Have you obtained or are you trying to obtain, or are you aware of any of your family or close relationships obtaining or trying to obtain, directly or indirectly, any loans, advances, grants, or any other financial instrument with any person or entity (bank, insurance company, etc.) with which you have also been dealing as part of your work with or position at NetZero?
Please provide details

Gifts, hospitality, and advantages
Have you received, or are you aware of any of your family or close relationships receiving, directly or indirectly, any gifts or items of value worth more than USD 100 from third parties because of your work with or position at NetZero?
Please provide details
Have you received, or are you aware of any of your family or close relationships receiving, directly or indirectly, any entertainment, events, trips, meals, hospitality, or other advantage worth more than USD 100 from a third party because of your work with or position at NetZero?
Please provide details
Have you received, or are you aware of any of your family or close relationships receiving, personal discounts or other benefits from suppliers, service providers, distributors, or customers of NetZero?
Please provide details

Other
Is there any other personal interest or relationship that might impair, or even appear to impair, your ability to make objective decisions in the interest of NetZero?
Please provide details

Final declaration
I hereby declare that all information provided in this form is true, accurate, and complete.
Signature
Should be Empty:

Identity