Employee - Conflict of Interest

Date:

[company name]

[employee name]

I have received a copy of the company's policy on conflicts of
interest. I have read and understand the policies on conflicts
of interest. I hereby declare that to the best of my knowledge I
nor any member of my immediate family has any conflict between
our personal affairs and the proper performance of my
responsibilities for the company that would constitute a
violation of the company's policies. I also declare that I will
continue to maintain my affairs in accordance with the company's
policy on conflicts of interest.


________________________
Employee