CONFLICT OF INTEREST

Name
MM slash DD slash YYYY
1. I or related parties hold, directly or indirectly, a position of ownership, control, or financial interest in an outside entity from which SAT-7 N.A. or its affiliate does business or otherwise has dealings.
2. I or a related party render or have rendered directive, managerial, or consultative services to, or am or have been an employee of, any outside entity that does business or otherwise has dealings with SAT-7 N.A. or its affiliate.
3. I or a related party have accepted gifts, loans or benefits (totaling more than $10), during the past year, from an outside entity that does, or is seeking to do business with SAT-7 N.A. or its affiliate.
4. I have participated in management decisions concerning transactions that could personally benefit me or a related party. If yes, please give full details below.
5. I or related parties have been indebted to SAT-7 N.A. or its affiliate at some time during the above stated period. (If yes, please note below the nature, date, terms, and amount of indebtedness.)
6. SAT-7 N.A. or its affiliate has been indebted to me or a related party at some time during the above stated period. (If yes, please note below the nature, date, terms, and amount of indebtedness.)
7. I or a related party own an interest in a business in which SAT-7 N.A. or its affiliate holds an interest that reasonably could affect the value of my interest or that of a related party’s.
8. I or related parties have invested in a non-publicly traded business in which a Decision Maker of SAT-7 N.A. or its affiliate either owns more than 5% of the voting stock, or in any way exercises control of the business.
9. I or related parties have obtained an interest in real estate, non-publically traded securities or other property that SAT-7 N.A. or its affiliate is considering, or may reasonably consider buying or leasing.
10. I or a related party am currently engaged in, or have been engaged in the last five years, in any transaction in which an economic benefit was provided to me or a related party, directly or indirectly, and the value of the economic benefit provided exceeded the value of consideration received by SAT-7 N.A. or its affiliate (including the value of services performed) for providing such benefit.
11. I have used SAT-7 N.A.’s or its affiliate’s personnel, equipment, supplies, good will, or staff time for personal affairs or activities other than SAT-7 N.A. or its affiliate-approved programs and purposes.
I have carefully read the attached Conflict of Interest Policy and have accurately and fully completed this Annual Conflicts of Interest Questionnaire. In signing this certificate, I have considered not only the literal expression of the policy, but also its intent. I hereby certify that, except as stated on the Questionnaire, I do not, to the best of my knowledge, have any interests conflicting with the interests of this organization, nor do I have any relationship that may appear conflicting. If any situation should arise in the future which I think may involve a conflict of interest, I will promptly and fully disclose the circumstances to the President, directly or through my immediate superior.
I also affirm the attached Statement of Faith Policy.

Sat 7 Logo
Copy link
Powered by Social Snap