Form ID: FIN‑FRM‑ETH‑002-V1
Version: 1.0
Effective Date: [Insert Date]
Owner: Finance Department
Review Cycle: Annual

This declaration is required annually and whenever circumstances change (e.g., new outside interests, gifts, or relationships). It supports the Finance Department Code of Ethics & Conduct (POL‑FIN‑ETH‑001) and the ISO‑aligned Finance Policy (POL‑FIN‑001).

A. Employee Details

• Name: ________________________________________________

• Position/Title: ________________________________________

• Entity/Department: _____________________________________

• Work Location: ________________________________________

• Employee ID: _____________

• Email / Phone: _________________________________________

B. Annual Acknowledgements (tick ☐)

☐ I have read and understood POL‑FIN‑ETH‑001 Finance Code of Ethics & Conduct and agree to comply with it.
☐ I have read POL‑FIN‑001 Finance Department Policy and SOP‑FIN‑001 Finance SOP relevant to my role.
☐ I completed the annual ethics training (date): ____ / ____ / ______.
☐ I understand my confidentiality obligations regarding financial, payroll, personal, and bank information.
☐ I will not engage in fraud, bribery, kickbacks, or facilitation payments and will report suspected misconduct.
☐ I will maintain accurate records and follow Delegation of Authority (DOA) and bank mandate controls.
☐ I understand this form must be updated within 14 days if my circumstances change.

C. Conflicts of Interest (COI) — Declaration

Question C1. Do you have any actual, potential, or perceived conflicts of interest related to your Finance duties (e.g., family/close relationships with suppliers/customers/employees; outside employment; ownership or financial interests; advisory roles; personal loans; or any situation that could influence objectivity)?

• ☐ No conflicts to declare (skip to Section D)

• ☐ Yes (complete table below and attach details)

COI Disclosure Table

Attachments: ☐ COI memo ☐ Contract/Offer ☐ Shareholding proof ☐ Other: ___________________

D. Gifts, Hospitality & Entertainment — Declaration

Question D1. In the last 12 months, did you offer, request, receive, or accept any gift, hospitality, travel, or entertainment from current/prospective suppliers, customers, banks, or advisors related to your Finance role?

• ☐ No (skip to Section E)

• ☐ Yes (complete table below)

Gifts & Hospitality Register Extract

Note: Cash or equivalents (vouchers, gift cards) are prohibited. Anything above K[Insert threshold] requires pre‑approval by the Financial Controller.

E. Outside Employment, Directorships & Financial Interests

Question E1. Do you hold any outside employment, consultancy, directorships, trusteeships, or board/advisory roles?

• ☐ No

• ☐ Yes (provide details): ___________________________________________________________

Question E2. Do you hold any financial interests (shares, options, beneficial interests) in entities that are current or potential suppliers/customers/banks/competitors?

• ☐ No

• ☐ Yes (provide details): ___________________________________________________________

Question E3. Do you have any close personal relationships with individuals employed by or owning a current/potential supplier, customer, or bank?

• ☐ No

• ☐ Yes (provide details): ___________________________________________________________

F. Data Privacy, Confidentiality & Security

☐ I will protect confidential and personal data, use only approved systems, and follow least‑privilege access.
☐ I will not share credentials or bank tokens and will report suspected compromise immediately.
 

G. Declaration & Signature

I declare that the information provided is true, complete, and accurate to the best of my knowledge. I understand that omissions or false statements may result in disciplinary action. I agree to update this declaration within 14 days of any change.

• Employee Name (print): __________________________________________

• Signature: _______________________________

• Date: ____ / ____ / ______

H. Reviewer Section (Finance Use Only)

Reviewed by Finance Manager

• Name: __________________________________ Signature: ______________________ Date: ____ / ____ / ______

• Findings/Notes: ________________________________________________________________

• COI Register (FIN‑REG‑COI) Entry #: _____________

• Gifts Register (FIN‑REG‑GIFT) Entry #(s): _________________________

• Mitigations/Recusals Required: ☐ Yes ☐ No
  If Yes, describe and record owner/dates: ____________________________________________

Financial Controller Approval (if required)

• Name: _________________________________ Signature: ______________________ Date: ____ / ____ / ______

Follow‑ups / CAPA (if any)

• FIN‑REG‑CAPA Ref: ______________________ Owner: __________________ Due: ____ / ____ / ______

I. Submission & Retention

• Submission: Return the signed original to Finance by [Insert annual due date, e.g., 31 January] or within 14 days of any change.

• Storage: File in the controlled repository under \Finance\Ethics‑Compliance\Declarations.

• Retention: Keep for ≥ 7 years (or longer per law/contract).

• Confidentiality: Declarations are confidential; access is limited to authorized reviewers.