Appendix G3 - Director Declaration Of Interests Form Template (Page 2 of 2) in pdf

Appendix G3 - Director Declaration Of Interests Form Template Page 2

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:

_______________________________________________________________

Position:

_______________________________________________________________

Date:

_______________________________________________________________

This form is based on a model produced by the Institute of Chartered Secretaries and

Administrators

and is reproduced with their kind permission.

Appendix G3 Responsible Finance Provider Handbook - Governance

Page 2

Appendix G3 - Director Declaration Of Interests Form Template Page 2