Employee - Conflict of Interest Legal Form

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.