Personal Interest Declaration

Personal Interest Declaration
This Scouts NSW internal Personal Interest Declaration for the period between 1 January and 31 December annually, is for all personnel, volunteers, employees, contractors and sub-contractors to abide by, when conducting procurement of goods and services for the benefit of Scouts NSW.
I, (name)*

First NameLast Name
of, (address)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Scout formation or work location*
Membership or employee number
hereby declare

that I am a current member or employee of Scouts NSW involved in the procurement of goods and services and I declare that I will have no personal benefit (financial or otherwise) derived by any Scouts member, their families or friends from the procurement of these goods and services, unless a specific and written exception has been provided by the Chief Executive officer of Scouts NSW.
and

that I am also a Contractor or Sub-Contractor providing goods and/or services to Scouts NSW and I declare, at the beginning of each engagement, that No Scouts member, their families or friends will receive any personal benefit (financial or ‘otherwise’) in the event of the selection of me/my business as a Contractor, Sub-Contractor or Supplier for the agreed project/works. ‘Otherwise’ refers to, but is not limited to, in-kind items such as goods, services, favours, use of facilities, etc.
Signature*

Clear
Date*

DayMonthYear
Date
Should be Empty: