Conflict of Interest Declaration and
Confidentiality Agreement
Document Purpose
The purpose of this document is to enable Te Whatu Ora – Health New Zealand, to identify and
manage conflicts of interest during a procurement activity to ensure that decisions are made on
proper grounds, for legitimate reasons and without bias. Anyone involved in any procurement activity
including dispensations and extensions must complete and sign a Conflict of Interest Declaration and
Confidentiality Agreement before developing tender documents, joining an evaluation panel or making
a decision.
Procurement Lead
Act
Project Name
Project Reference
Number
What is a conflict of interest?
A conflict of interest arises if a person’s personal interests or obligations conflict with or could
compromise that person’s professional responsibilities. In such a situation, that person’s
independence, objectivity, or impartiality can be called into question. A conflict of interest can be:
•
Actual: where the conflict already exists;
Information
•
Potential: where the conflict is about to happen, or could happen; or
•
Perceived: where other people might reasonably think that a person has been compromised.
Conflict of Interest Declaration
Do you have any personal interest in the purchasing decision?
☐ Yes
☐ No
☐ Potential
(e.g., you own shares in a supplier or related company)
Official
Are you a relative or close friend of someone with a personal
interest in the goods or services being purchased or who could be
personally affected by the purchasing decision?
☐ Yes
☐ No
☐ Potential
the
(e.g., a family member is an employee or shareholder of a
supplier)
Do you have any personal obligations, loyalties or bias that could
influence the way you evaluate offers and recommend
☐
purchases?
Yes
☐ No
☐ Potential
under
(e.g., a close friendship with an employee of a supplier)
Have you recently been offered any special discounts, gifts, trips,
hospitality, rewards, or favours by suppliers of the goods or
☐
services being purchased?
Yes
☐ No
☐ Potential
(e.g., free travel; free samples for your own use)
Are you aware of anything that could give the appearance that
you might be biased towards or against a particular supplier?
(e.g., you have expressed strong views about a supplier; you
☐ Yes
☐ No
☐ Potential
worked for a supplier; you use a supplier’s corporate box at a
Released
sports event)
Details of a Declared Conflict of Interest
NONE
Conflict of Interest Undertaking
•
I confirm that I have read and understood the conflict of interest information provided by the
Ministry of Business, Innovation and Employment (click
here) and will act in accordance with
the guidelines set out for the duration of the procurement activity.
CoI Declaration and Confidentiality Agreement – Te Whatu Ora – Health NZ v2
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Last Modified: 01/03/2023
Conflict of Interest Declaration and
Confidentiality Agreement
•
I undertake to immediately notify Te Whatu Ora – Health New Zealand of any actual, potential,
or perceived conflict of interest which may arise during my involvement with the procurement
activity.
•
If I am unsure or have any doubt about whether any conflict of interest (actual, potential, or
perceived) exists, I will immediately notify Te Whatu Ora – Health New Zealand.
Confidentiality Undertaking
I am aware that all the procurement activity material (hard & soft copies), including discussions,
correspondence and advice is confidential information (
Confidential Information). I undertake and Act
agree to:
•
only use Confidential Information for the purposes of the procurement activity;
•
not to divulge Confidential Information to any person not involved in the procurement activity
without prior approval of the original holder of the Confidential Information (Te Whatu Ora –
Health New Zealand or the respondent as applicable);
•
take all reasonable measures to securely store all Confidential Information in my possession;
•
return all confidential material to Te Whatu Ora – Health New Zealand, or have the confidential
material securely destroyed at the end of my involvement with the procurement activity;
•
not to provide comment on the procurement activity or other Te Whatu Ora – Health New
Zealand contract activities to anyone outside the procurement activity including the media;
Information
•
refer all questions to Te Whatu Ora – Health New Zealand (including where I am unsure or
have any doubt about whether any information is Confidential Information); and
•
refer all media enquiries to Te Whatu Ora – Health New Zealand.
Restrictions on contact with suppliers
During the period the procurement activity is open, (including the evaluation and negotiation phases
Official
and up until the formal announcement of the successful supplier/s) I undertake not to do any of the
following without the prior approval of Te Whatu Ora – Health New Zealand:
•
pass information or make comments to any potential supplier about the procurement activity;
the
•
receive any gift, gratuity, hospitality, benefit, or inducement from a potential supplier; or
•
meet with a potential supplier to discuss the procurement activity or any other Te Whatu Ora –
Health New Zealand contract activities (except for business as usual contact with existing
suppliers).
I will immediately advise Te Whatu Ora – Health New Zealand of any requests for information or
under
meetings in relation to the procurement activity that I receive from a potential supplier.
Declaration
I hereby declare and confirm that the above details are correct to the best of my knowledge and I
make this declaration in good faith. I agree to be bound by the above undertakings.
Full Name:
Position:
Organisation:
Role in Activity:
Released
Signature:
Date:
CoI Declaration and Confidentiality Agreement – Te Whatu Ora – Health NZ v2
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Conflict of Interest Declaration and
Confidentiality Agreement
Conflict of Interest Management Plan
Where any actual, potential, or perceived conflicts of interest have been declared above, the following
plan to manage, mitigate or eliminate such conflict will be implemented. This plan considers the likely
effect of the conflict of interest on the conflicted person’s role and responsibilities in the procurement
activity, as well as the risks to Te Whatu Ora – Health New Zealand’s processes and reputation.
To be completed by the Te Whatu Ora – Health New Zealand Procurement Lead:
Restrict
Imposing restrictions on the person’s further involvement in the matter.
Act
[Insert description]
Recruiting
Engaging an independent third party to oversee all or part of the process and verify its integrity.
[Insert description]
Information
Removing
Where the person chooses, or is asked, to be removed completely from the matter.
[Insert description]
Official
Relinquishing
the
Where the person relinquishes the private interest that created the conflict.
[Insert description]
under
Resigning
Where the person resigns from their position with the agency.
[Insert description]
Approval: Conflict of Interest Declarer
Released
I approve the above Conflict of Interest Management Plan.
Name:
Signature:
Date:
CoI Declaration and Confidentiality Agreement – Te Whatu Ora – Health NZ v2
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Last Modified: 01/03/2023
