Conflicts of interest declaration form

Please give below details of all private, professional or commercial interests that may conflict with the interests of UK Research and Innovation (UKRI).

You should declare all those interests which members of the public may reasonably think could influence or bias your judgement.

The information you provide below should relate to the period 1 April 2021 to 31 March 2022.

1. Name of the person / team who asked you to complete this form *

2. Your name *

3. Primary role/post with UKRI *

4. Professional memberships or affiliations *

5. Other roles/services provided to UKRI in addition to primary role *

6. Appointments, employment, directorships and consultancies with other organisations *

7. Roles in organisations receiving UKRI support where you receive remuneration / benefits in kind / other income received. *

8. Unremunerated involvement with relevant bodies *

9. Direct investments (shareholdings, dependencies and/or other financial interests) *

10. Direct investments in organisations receiving UKRI funding and/or support *

11. Financial, pecuniary and non-financial links of close family members in above areas *

Please check the boxes below to complete your submission

By submitting this form: *

I understand my responsibilities for providing an up-to-date and accurate declaration and confirm that this form captures my outside interests and those of my close family.
I understand that failing to make an accurate declaration may be treated as a disciplinary matter by UKRI or lead to termination of my contract with UKRI.