Form for Declaration of Conflict of Interest 申報利益衝突表格

JELLY BEAN SOCIETY LIMITED

紅豆會有限公司

Form for Declaration of Conflict of Interest

申報利益衝突表格

Part A – Declaration of Interest

甲部 – 利益申報

To: *Secretary / President of the Council

致: *幹事會 秘書 / 會長

I understand that if I, my family members and close relatives and personal friends have any direct or indirect interest in any company which has business dealings with the Fraternity, I shall make a declaration to the Council.

本人明白，如本人、家庭成員、親屬及私交友好持有與同學會有業務來往之任何公司的直接或間接利益，須向幹事會申報。

I would like to declare the following existing / potential* conflict of interest situation arising from the discharge of my duties concerning the operation of the Fraternity or as members of the Council:-

本人現申報本人在同學會中或身為幹事會成員在履行職務時存在 / 可能引起*利益衝突的情況：

a) Persons / companies with whom / which I have official dealings and / or private interests :

本人與其有公事往來及 / 或本人擁有個人利益的人士 / 公司：

b) Brief description of my duties which involved the persons / companies mentioned in item (a) above

本人與上文（a）項所述人士 / 公司有關的職務概要：

Signature: 簽署：

Position and Name: 姓名及職位：

Date: 日期：

 (*Delete as appropriate)

（*請刪去不適用者）

Part B – Record of Resolution of the Council

乙部 – 幹事會決議紀錄

With respect to the above declaration, the Council passed the following resolution:

有關上述申報人申報利益一事，幹事會通過決議如下：

☐ (name of the person making the declaration) should refrain from performing or getting involved in performing the work / duty, as described in Part A, which may give rise to a conflict.

（申報人姓名）應避免執行或參與甲部中提及可能引致利益衝突的工作 / 職務。

☐ (name of the person making the declaration) may continue to handle the work / duty as described in Part A, provided that there is no change in the information declared above.

如甲部的申報資料沒有更改，（申報人姓名）可繼續處理甲部中提及的工作 / 職務。

☐ Others (please specify)

其他決議 / 事項（請說明）

Signature: 簽署：

Signature: 簽署：

(President/會長)

(Secretary/秘書)

Date of Meeting: 會議日期：

END OF DOCUMENT