Declaration of Interests

Please answer each question. If you select “Yes,” a text box will appear for you to provide details. This form is confidential and will be managed in accordance with the Carer Escapes Conflict of Interest Policy and Privacy Policy.

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Name*

First Last

Email Address*

Position/Role*

Date*

DD slash MM slash YYYY

Do you, or a close family member, have any financial interest (e.g., shareholding, directorship, employment, contract) in any organisation that does business with or may seek to do business with Carer Escapes?*

Yes

No

Please provide details*


Do you have a close personal relationship (e.g., family, partner, close friend) with any person involved in Carer Escapes’ activities, services, or decision-making?*

Yes

No

Please provide details*


Do you hold any other roles (e.g., board member, employee, volunteer) in another organisation that may have interests conflicting with those of Carer Escapes?*

Yes

No

Please provide details*

Are there any other interests, activities, or relationships that could be perceived as a conflict of interest?*

Yes

No

Please provide details*

Declaration*

I declare that the information provided above is true and complete to the best of my knowledge. I understand that I must promptly update this declaration if my circumstances change and a new or potential conflict arises.

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I am a human

I am a human

Phone

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