I,   First Name*   Last Name*  solemnly swear that the above information is true and answered to the best of my knowledge and ability.

This is to certify that as a POC Ethics Committee member I,First Name*   Last Name*, understand that any information (written, verbal, or any other form) obtained during the performance of my duties as an Ethics Committee member must remain confidential. This includes all information about a complaint itself as well as the identities of those participating in a complaint procedure.

I understand that any unauthorized release or carelessness in the handling of this information is considered a breach of the duty to maintain confidentiality. Devices containing confidential information must be kept private and/or password protected.

I further understand that any breach of the duty to maintain confidentiality may be grounds for immediate removal from the Ethics Committee and the initiation of an ethics violation complaint against me.