Conflict of Interest Sample Disclosure Annual Statement

I have read and understand the Conflict of Interest Policy. I hereby declare and certify the following real or apparent conflict(s) of interest:

Disclosure Statement



(If necessary, attach additional documentation.)

I agree to promptly inform the board upon the occurrence of each event that could potentially result in my involvement in (or implication in) a conflict of interest.

      Date                                               Signature

This text is provided with the understanding that ECFA is not rendering legal, accounting, or other professional advice or service. Professional advice on specific issues should be sought from an accountant, lawyer, or other professional.