Declaration on Conflicts of Interest

All Fellows and senior staff of Mansfield College must declare conflicts of interest, and make a full written disclosure of their interests, gifts/hospitality received, relationships and holdings that could potentially result in a conflict of interest.

The form below should be completed annually.

Declaration of Interests Form

As Fellow/staff member of Mansfield College, this form sets out my interests in accordance with the College's Conflicts of Interest Policy.

Name

Job title/role at Mansfield College

Please give details of any current employment or previous contractual relationships other than with the College, in which you continue to have a financial interest (eg, directorships, partnerships, offices or advisory appointments or lobbying appointments). Please state whether it applies to yourself or, where appropriate, a member of your immediate family or other close relative. If you have none, please write "none".

Please give details of any appointments (voluntary or otherwise) eg, trusteeships, directorships, local authority memberships, tribunals, etc). Please state whether it applies to yourself or, where appropriate, a member of your immediate family or other close relative. If you have none, please write "none".

Please give details of membership of any professional bodies, special interest groups, lobbying groups or mutual support organisations. Please state whether it applies to yourself or, where appropriate, a member of your immediate family or other close relative. If you have none, please write "none".

Please give details of any gifts or hospitality in excess of £50 accepted from any individual or organisations in respect of your position within the College in the last twelve months. Please state whether it applies to yourself or, where appropriate, a member of your immediate family or other close relative. If you have none, please write "none".

Please give details of any contractual relationship with the College other than a contract of employment. Please state whether it applies to yourself or, where appropriate, a member of your immediate family or other close relative. If you have none, please write "none".

Please give details of any relation to a relative or close friend or associate's interests. Please state whether it applies to yourself or, where appropriate, a member of your immediate family or other close relative. If you have none, please write "none".

Please give details of any other conflicts that are not covered by the above. Please state whether it applies to yourself or, where appropriate, a member of your immediate family or other close relative. If you have none, please write "none".

I confirm that, to the best of my knowledge, the above information is complete and correct. I undertake to update as necessary the information provided, and to review the accuracy of the information on an annual basis and as soon as practicable after any changes. I give my consent for it to be used for the purposes described in the conflicts of interest policy and for no other purpose.(Required)

Yes

Name

First Last

Date

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Declaration on Conflicts of Interest

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