Sample conflict of interest form

Trustees are required to declare any outside interests that may conflict with their trustee work

Conflicts of Interest

As a trustee, you are required to act in the best interests of 'X' charity. However, inevitably, trustees have a wide range of interests in private, public and professional life and these interests might, on occasions, conflict, (for example: Director of supplier or consultant to charity).

We are obliged to review any possible conflicts when preparing our annual report so ask you to supply the following details:

• Has 'X' charity made any loans to you?
• Have you, or people connected with you through family, business or another charity, an interest in a contract or transaction with 'X' charity?
• Have you or any person connected with you derived any pecuniary benefit or gain from 'X' charity?

Signed: __________________ Date: ____________