CONFLICTS OF INTEREST

Appendix 2: Form for addressing potential or actual Conflicts of Interest

Appendix 1.a: Declaration Form

Editable

I, the undersigned:

Mr./Ms. *

Holding the position/duties of *

I hereby declare:

That I am currently not in any potential or actual Conflict of Interest situation.

That I have or may have the following Conflict(s) of Interest:

I undertake to immediately inform my managers of any evolution of this Conflict of Interest.

Two original copies signed in *

Date

Employee's Signature *

Appendix 1.b: Analysis Grid

Editable

Declarant's Position/Duties
Description of the company or entity	asdsad
Description of operations or transactions	asdsad
Financial magnitude	sad
Potential influence	sadsa
Other relevant information	sdsadsad

First and last name of the Declarant *

Date *

To be completed by the line manager and Compliance Officer during the interview with the employee, to agree on any further steps to be taken with respect to the situation, and after possible consultation with Human Resources, Legal and/or Ethics departments.

First, last name and Position/Function of the manager *

First and last name of the Compliance Officer *

	Last Name	First Name	Position/Function	Opinion, if any
Human Resources				sd
Legal Department				asd
Ethics Department				sdsad

Mitigation Measures for addressing the Conflict of Interest:

Content of the measure	Duration	Person responsible for implementation	Action
sad
asd
sadsad
sadsad
asd

Three originals signed in *

Employee Signature

Manager Signature

Compliance Officer Signature

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