CONFLICT OF INTEREST / HOSPITALITY DECLARATION FORM
I, .....................................................................................................................................................................
(Name)
confirm I have received the following hospitality/declare the following conflict of interest
from/with ......................................................................................................................................................
(Name of entity providing hospitality/with whom there is a conflict of interest)
.........................................................................................................................................................................
(Describe, hospitality/conflict of interest)
valued at $.....................................................................................................................................................
(Signed)
(Date)
If total value of hospitality (over a 12 month period) is valued at over $100.00 have
your line manager complete. Prior approval was given for the above hospitality.
(Name)
(Signed)
(Date)
Please send completed form to:
Disclosure Register
Corporate Office
2nd Flr, H Block
TPMH