Declarations of Interest Register
I _________________________________ as Independent Strategic Advisory Board (ISAB) member / employee / volunteer of Healthwatch Kingston Upon Hull have set out below my interests in accordance with the organisation’s conflicts of interest policy.
|Please give details of the interest and whether it applies to yourself or, where appropriate, a member of your immediate family, connected persons or some other close personal connection.|
|Current employment and any previous employment in which you continue to have a financial interest.|
|Appointments (voluntary or otherwise) eg. trusteeships, directorships, local authority membership, tribunals etc.|
|Membership of any political or professional bodies, special interest groups or mutual support organisations.|
|Investments in unlisted companies, partnerships and other forms of business, shareholdings and beneficial interests.|
|Gifts or hospitality offered to you by external bodies and whether this was declined or accepted in the last twelve months.|
|Any contractual relationship with Healthwatch Kingston Upon Hull or Meeting New Horizons CIC.|
|Any other conflicts that are not covered by the above.|
To the best of my knowledge, the above information is complete and correct. I undertake to update as necessary the information provided, and to review the accuracy of the information on an annual basis. I give my consent for it to be used for the purposes described in the conflicts of interest policy and for no other purpose.
Print Name: _________________________________________________________