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CONFLICT OF INTEREST STATEMENT ND DEPARTMENT OF COMMERCE/DCS SON 59337 (1/10) I, a member of the Regional Council Scoring and Ranking Committee, hereby attest and subscribe to the following: I understand

How to fill out conflict of interest statement

How to fill out a conflict of interest statement:

1. Begin by providing your personal information at the top of the form, including your name, title or position, and contact details.
2. Clearly state the purpose of the conflict of interest statement, explaining that it is a declaration of any potential conflicts that may arise in your professional or personal life.
3. Identify any organizations, businesses, or entities with which you are associated that could potentially create a conflict of interest. This could include companies you own, boards you serve on, or relationships with other individuals or organizations that may compromise your impartiality.
4. Specify the nature of the conflict of interest and how it may impact your ability to act objectively in certain situations. Be as specific as possible in describing the potential conflicts and their implications.
5. Include any steps you will take to mitigate or address the conflict of interest. This could involve abstaining from certain decision-making processes, seeking independent advice, or disclosing the conflict to relevant parties.
6. Sign and date the conflict of interest statement to confirm that the information provided is accurate and complete.

Who needs a conflict of interest statement:

1. Employees or representatives of organizations that operate in industries where conflicts of interest are likely to occur, such as finance, insurance, government, academia, or healthcare.
2. Members of boards, committees, or governing bodies who have decision-making authority and are responsible for acting in the best interests of the organization they represent.
3. Professionals involved in research, consulting, or provision of services where conflicts of interest may arise due to financial incentives or competing interests.
4. Individuals in positions of power or influence who have the ability to impact the outcome of certain decisions or transactions and therefore need to disclose any potential conflicts.

Remember, the need for a conflict of interest statement may vary depending on the specific job role, industry, and organizational policies. It is always important to consult with your organization's ethics or compliance department to determine if and when a conflict of interest statement is required.

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What is conflict of interest statement?

A conflict of interest statement is a document that discloses any potential conflicts that an individual may have between their personal interests and their professional responsibilities.

Who is required to file conflict of interest statement?

Certain individuals such as employees, board members, or executives may be required to file a conflict of interest statement depending on the organization's policies and regulations.

How to fill out conflict of interest statement?

To fill out a conflict of interest statement, one must typically disclose any financial interests, relationships, or activities that could potentially influence their decision-making in a professional setting.

What is the purpose of conflict of interest statement?

The purpose of a conflict of interest statement is to promote transparency and integrity within an organization by identifying and managing potential conflicts of interest.

What information must be reported on conflict of interest statement?

Information such as financial interests, relationships, investments, and any other potential conflicts that could impact an individual's objectivity or decision-making should be reported on a conflict of interest statement.