Conflict of Interest Disclosure Form Template

The Conflict of Interest Disclosure Form identifies and records any external interests that could influence an individual’s role or decision-making within an organization. It gathers information about financial interests, outside roles or personal relationships that may pose a conflict.

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Conflict of Interest Disclosure Form with sections for declaration, conflict details, mitigation steps and certification

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Conflict of Interest Disclosure Form with sections for declaration, conflict details, mitigation steps and certification page 1

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Frequently asked questions

The Conflict of Interest Disclosure Form is used to document personal, financial or professional interests that may affect an individual's responsibilities within an organization. It collects details about outside relationships, roles or activities and allows individuals to identify potential conflicts. The form also includes space to describe mitigation steps and a certification section to ensure accuracy.
Employees, officers, board members and individuals in decision-making roles complete the form to disclose potential or actual conflicts.
Submit the completed form to the organization’s HR, governance or compliance office for review and recordkeeping.

Conflict of Interest Disclosure Form Template

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