Conflict of Interest Form Template

Annual COI packets stall in email. This conflict of interest form template lets employees and board members disclose relationships and sign an attestation from their phone.

Great for

• Annual employee and contractor COI attestations
• Board and committee member disclosures
• Vendors and partners completing a one-time disclosure

Ask a clear yes or no first, then give space to describe anything that might look like a conflict. Keep your full policy link in the form description or a follow-up email.

Use a real signature field so the attestation is harder to dispute than a typed name alone. Export CSV when compliance needs a year-end archive.

Questions in this template

1. Full legal name *
   Name
2. Work email *
   Email
3. Role or title *
   Short text
4. Department or team
   Short text
5. Do you have any potential conflicts of interest to disclose? *
   Yes or no
6. Describe any financial, family, or outside relationships that could affect your work *
   Long text
7. Related person or organization (if any)
   Short text
8. How are you managing or planning to manage this?
   Long text
9. I have read and understand the company conflict of interest policy *
   Yes or no
10. I confirm the information above is complete and accurate to the best of my knowledge *
    Yes or no
11. Signature *
    Signature
12. Today's date *
    Date