Declaration of interests form

The information entered in the form will be stored on the Vetlife  internal website and may be published on public request. Personal or sensitive information should be disclosed privately to the President or Company Secretary. See the Vetlife Conflicts of Interest Policy here.

"*" indicates required fields

Name*
Current Shareholdings - of relevance to the veterinary community e.g. in pharmaceuticals companies, corporate veterinary practice, consultancy/advisory/recruitment firms, training/coaching/mentoring agencies, farming, food, etc. (Note: this refers to specific major holdings and does not include general pension, savings and externally managed investments portfolios)

Current Shareholdings*
Company/organisation
Nature of Business
 
Add N/A if not applicable

Current Consultancies*
Company/organisation
Nature of Business
 
Add N/A if not applicable

Current Membership and/or Fellowships of other veterinary or allied organisations*
Company/organisation
Nature of Business
 
Add N/A if not applicable

An example of an indirect grant would include, for example, a grant to a member of immediate family, close relative or friend. Add N/A if not applicable

Employment - practice, industry, university, etc; past and present.*
Practice/ Company/Organisation
Years (from – to)
Role
 
Add N/A if not applicable


Add N/A if not applicable

Add N/A if not applicable
I hereby declare that in returning this form I accept and will abide by the Vetlife Code of Conduct for Managing Potential Conflicts of Interest.

Authorisation
By returning this information electronically, I confirm that the information contained is an accurate reflection of interests, and agree that the above information can be held on file at Vetlife and may be used in response to specific and relevant requests for information.

MM slash DD slash YYYY

AET



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