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Conflict of Interest Declaration Form Template

Ensure Transparency with Our Conflict of Interest Declaration

Unaddressed conflicts can lead to serious breaches of trust within your organization. This Conflict of Interest Declaration Form Template is designed to help you and your staff openly declare any potential conflicts, ensuring accountability and integrity. With this template, you can easily collect vital declarations, enhance compliance, streamline the reporting process, and foster a culture of transparency. Plus, it's crafted for easy customization, making it straightforward for your team to use-explore the live template now.

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Full name
Job title or role
Department or unit
Organization or company
Work email
Work phone
Do you have any actual, potential, or perceived conflicts of interest to declare?
Yes
No
Unsure
Does your declaration include interests of an immediate family member or a close personal relationship?
Yes
No
Not applicable
Which types of interests are involved? Select all that apply.
Please Specify:
Entities or individuals involved (list names and relationships)
Describe the nature of the interest and your role
Interest start date
Interest end date (if applicable)
Estimated value or magnitude (if applicable)
Is the interest ongoing?
Yes
No
Not applicable
Could this interest influence, or appear to influence, your professional decisions in your role?
Yes
No
Unsure
Additional details or context
Proposed management or mitigation actions
Recusal from related decisions
Disclosure to team, clients, or students
Divestment or resignation from role
Independent oversight or reviewer
Limit access to sensitive information
Not sure; need guidance
Other
Please Specify:
I have read and will comply with the organization's conflict of interest policy.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I certify that the information provided is true and complete to the best of my knowledge.
Yes
No
Type your full name as your signature
Signing date
I will promptly update this declaration if my circumstances change.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
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paper art illustration depicting a conflict of interest declaration form for FormCreatorAI article

When to use this form

Use this form when someone involved in hiring, procurement, research, grants, or governance could have outside ties that affect a decision. For example, a committee member reviewing vendor bids, a researcher funded by a sponsor, a manager with a relative applying for a job, or a board member holding shares in a partner. HR, compliance, and legal teams benefit from clear disclosures and an audit trail before approvals. If money or holdings are involved, pair it with the Financial declaration form. For statements that must be made under oath, add a Sworn statement form. To confirm signer identity and signature, include a Signature attestation form.

Must Ask Conflict of Interest Declaration Questions

  1. Do you, a family member, or a business you control have any financial interests related to this matter?

    This surfaces ownership, investments, loans, or royalties that could bias judgment. Clear details let you assess risk and decide on mitigation.

  2. Have you received any gifts, hospitality, or benefits from interested parties in the past 12 months?

    Gifts can create perceived influence even when intent is benign. Capturing source, value, and dates helps you apply policy thresholds consistently.

  3. Do you hold any outside roles (employment, consultancy, board, or advisory) with an entity that interacts with our organization?

    Outside roles reveal loyalties that might conflict with duties here. If needed, document employment details in a Working declaration form to keep records complete.

  4. Could any personal relationships (family, close friends, or partners) influence your impartiality in this decision?

    Personal ties are a common, overlooked risk. Naming the relationship helps you plan recusal or add an independent reviewer.

  5. What mitigation steps will you take (recusal, disclosure to the group, independent review), and when will they occur?

    A concrete plan turns disclosure into action and protects process integrity. Dates and owners make follow-up easy to track and audit.

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