Declaration of Interest

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.
 

Category

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. 

Declaration
 
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.
 
Signed: _____________________________________________________________
 
Print Name: _________________________________________________________
 
Position: ____________________________________________________________
 
Date: _____________________

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