Disclouser of Pesonal/Business Relationships Form



Personal & Business Relationship Disclosure Form

Declaration from all persons working in Islamic Relief

CONFIDENTIAL

To avoid any potential conflict of interest and show compliance with Islamic Relief Code of Conduct, all Islamic Relief staff/new joiners must complete this form by giving honest and true information about personal relationship with any staff member of the Islamic Relief and declare any business ownership that may or may not have potential to be engaged in selling services/commodities to the Islamic Relief. Islamic Relief will use this information to avoid your engagement in any matter related to the persons/organizations declared in this form.

It is the responsibility of each individual working in Islamic Relief to declare his/her relationship with person/business that subsequently become related (through marriage/transfer of ownership/part time job etc).

In addition we ask that all persons declare the following:

Do you have any relative or personal relationship with staff members is/are currently working in Islamic Relief? (Please tick)

≤ YES ≤ NO

Do you have ownership in any business that had been or may have future potential of selling services/commodities to Islamic Relief? (Please tick)

≤ YES ≤ NO

If yes, please state below the Name & relationship/ownership:

FULL NAME (PRINT):

FATHER’S NAME:

COMPLETE ADDRESS:

CNIC #:

DATE OF BIRTH: PLACE OF BIRTH:

DECLARATION

I have read & understood the IR Code of Conduct and I hereby agree & abide by its contents.

I understand that, if it is found that I have withheld information or included any false or misleading information above, I will be removed from my post whether paid or voluntary, without notice. I understand that the information will be kept securely by the organization.

I hereby declare the information I have provided is accurate.

Signed: __________________________________ Date:

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