Conflict of Interest & Confidentiality Declaration Form.
This is designed to be built in Tally (or similar tools). It covers both the annual requirement for Staff/Directors (UL-P14) and the specific requirements for UHSC members.
File Location:
Reference: UL-P14-A3 (COI Procedure)
Title: Annual Conflict of Interest & Confidentiality Declaration
Description:
To ensure Unbound Living operates with integrity, all staff, directors, and advisory members must identify and declare any personal, professional, or financial interests that could influence—or be seen to influence—their professional judgement.
What is a Conflict of Interest?
A conflict exists if your personal interests (or those of a close family member or friend) compete with your duties at Unbound.
Common Examples:
Ref: UL-P14 Appendix 14.3
1. Full Name:
[ Short Text Answer ]
2. Your Role at Unbound:
[ Dropdown ]
3. Type of Declaration:
[ Multiple Choice ]
4. Financial Interests
Do you (or a close family member) hold any financial interest, shares, or ownership in a company that competes with Unbound or supplies services to us (e.g., Labs, Tech Providers, Wellness Brands)?
5. Professional Interests & Outside Employment
Do you hold any other employment, consultancy, or directorships outside of Unbound that could impact your ability to perform your role or create a conflict of loyalty?
6. Personal Relationships
Do you have any personal relationships with current Unbound suppliers, partners, or key service users that could influence business decisions (e.g., hiring, procurement)?
7. Gifts & Hospitality
Have you received any gifts, hospitality, or benefits (valued >£50) from a third party related to your work at Unbound in the last 12 months that have not already been declared?
8. Confidentiality Undertaking
Unbound Living entrusts you with sensitive information regarding members, commercial strategy, and clinical data.
By signing below, you agree that:
Do you agree to these terms?
9. Declaration Statement
I confirm that the information provided above is true, complete, and accurate to the best of my knowledge. I understand my responsibility to update this declaration immediately should my circumstances change.
Signature (Type Name):
[ Short Text Answer ]
Date:
[ Date Picker ]
These fields are hidden from the user but used in the backend (e.g., Google Sheets integration).