Conflict of Interest Disclosure Form
Vendor Selection Panel
Panel Member Information
Full Name
Position/Title
Department/Unit
Date
Vendor Selection Details
Project / Purchase / Tender Name
Your Role on Selection Panel
Conflict of Interest Disclosure
I declare that, to the best of my knowledge, I have no current or potential conflict of interest in relation to this vendor selection process.
I wish to disclose the following potential or actual conflict(s) of interest:
If any, please provide details:
Signature
Date