{"id":6689,"date":"2026-03-19T23:32:30","date_gmt":"2026-03-19T13:02:30","guid":{"rendered":"https:\/\/primanota.org.au\/?page_id=6689"},"modified":"2026-03-19T23:32:31","modified_gmt":"2026-03-19T13:02:31","slug":"conflict-of-interest-declaration-form","status":"publish","type":"page","link":"https:\/\/primanota.org.au\/ru\/conflict-of-interest-declaration-form\/","title":{"rendered":"Conflict of interest declaration form"},"content":{"rendered":"\n<div class=\"wp-block-uagb-container uagb-block-2b8629f3 alignfull uagb-is-root-container\"><div class=\"uagb-container-inner-blocks-wrap\">\n<div class='fluentform ff-inherit-theme-style fluentform_wrapper_63'><form data-form_id=\"63\" id=\"fluentform_63\" class=\"frm-fluent-form fluent_form_63 ff-el-form-top ff_form_instance_63_1 ff-form-loading ffs_inherit_theme\" data-form_instance=\"ff_form_instance_63_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Conflict of Interest Declaration<\/legend><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"ak_\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"202\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><input type='hidden' name='__fluent_form_embded_post_id' value='6689' \/><input type=\"hidden\" id=\"_fluentform_63_fluentformnonce\" name=\"_fluentform_63_fluentformnonce\" value=\"37f26a40bc\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/ru\/wp-json\/wp\/v2\/pages\/6689\" \/><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-63_1\" ><h2 style=\"font-family: 'Segoe UI', Arial, sans-serif;font-size: 20px;font-weight: 600;color: #1a1a1a;margin-bottom: 4px\">Conflict of Interest Declaration<\/h2><p style=\"font-family: 'Segoe UI', Arial, sans-serif;font-size: 14px;color: #666;margin-bottom: 0\">Prima Nota Inc.<\/p><hr style=\"border: none;border-top: 2px solid #e8e8e8;margin: 16px 0 8px 0\"><\/div><div data-type=\"name-element\" data-name=\"names\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_63_names_first_name_' id='label_ff_63_names_first_name_' >Full Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_63_names_first_name_\" class=\"ff-el-form-control\" placeholder=\"Full Name\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_63_role_on_committee' id='label_ff_63_role_on_committee' aria-label=\"Role on Committee\">Role on Committee<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"role_on_committee\" class=\"ff-el-form-control\" placeholder=\"e.g. Treasurer, Secretary, General Member\" data-name=\"role_on_committee\" id=\"ff_63_role_on_committee\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_63_declaration_date' id='label_ff_63_declaration_date' aria-label=\"Date\">Date<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Date \u0418\u0441\u043f\u043e\u043b\u044c\u0437\u0443\u0439\u0442\u0435 \u043a\u043b\u0430\u0432\u0438\u0448\u0438 \u0441\u043e \u0441\u0442\u0440\u0435\u043b\u043a\u0430\u043c\u0438 \u0434\u043b\u044f \u043d\u0430\u0432\u0438\u0433\u0430\u0446\u0438\u0438 \u043f\u043e \u0434\u0430\u0442\u0430\u043c. \u041d\u0430\u0436\u043c\u0438\u0442\u0435 Enter, \u0447\u0442\u043e\u0431\u044b \u0432\u044b\u0431\u0440\u0430\u0442\u044c \u0434\u0430\u0442\u0443.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"declaration_date\" id=\"ff_63_declaration_date\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"declaration_date\"  aria-invalid='false' aria-required=true><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-63_2\" ><hr style=\"border: none;border-top: 1px solid #e8e8e8;margin: 8px 0\"><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Nature of Interest\">Nature of Interest<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='nature_of_interest_f916431696a4b9e5914a844bece5af2e'><input  type=\"radio\" name=\"nature_of_interest\" data-name=\"nature_of_interest\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"financial\"  id='nature_of_interest_f916431696a4b9e5914a844bece5af2e' aria-label='Financial' aria-invalid='false' aria-required=true> <span>Financial<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='nature_of_interest_465f1972192e7cecf66a70f94db3547d'><input  type=\"radio\" name=\"nature_of_interest\" data-name=\"nature_of_interest\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"personal\"  id='nature_of_interest_465f1972192e7cecf66a70f94db3547d' aria-label='Personal \/ Relationship' aria-invalid='false' aria-required=true> <span>Personal \/ Relationship<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='nature_of_interest_dfe789a15925cbd389a5d7c1e1f1e5d4'><input  type=\"radio\" name=\"nature_of_interest\" data-name=\"nature_of_interest\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"business\"  id='nature_of_interest_dfe789a15925cbd389a5d7c1e1f1e5d4' aria-label='Business Interest' aria-invalid='false' aria-required=true> <span>Business Interest<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='nature_of_interest_d25835552b792398b5a72dbadacf8a2f'><input  type=\"radio\" name=\"nature_of_interest\" data-name=\"nature_of_interest\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"other\"  id='nature_of_interest_d25835552b792398b5a72dbadacf8a2f' aria-label='Other' aria-invalid='false' aria-required=true> <span>Other<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_63_conflicts_list' id='label_ff_63_conflicts_list' aria-label=\"Please list any organisations, roles, businesses, or affiliations that may present an actual, potential, or perceived conflict of interest with your role on the Prima Nota Management Committee:\">Please list any organisations, roles, businesses, or affiliations that may present an actual, potential, or perceived conflict of interest with your role on the Prima Nota Management Committee:<\/label><div class=\"ff-el-tooltip\" data-content=\"If you have no conflicts to declare, please write &quot;None&quot;.\"><svg width=\"16\" height=\"16\" viewBox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><textarea aria-required=\"true\" aria-labelledby=\"label_ff_63_conflicts_list\" type=\"textarea\" name=\"conflicts_list\" id=\"ff_63_conflicts_list\" class=\"ff-el-form-control\" placeholder=\"List each organisation, role, business, or affiliation separately. If none, write &quot;None&quot;.\" rows=\"6\" data-name=\"conflicts_list\" ><\/textarea><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-63_3\" ><hr style=\"border: none;border-top: 1px solid #e8e8e8;margin: 8px 0\"><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Declaration\">Declaration<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='declaration_checkbox_9f62f14202e0d2f112466524ac8f8bc9'><input  type=\"checkbox\" name=\"declaration_checkbox[]\" data-name=\"declaration_checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"declaration_confirmed\"  id='declaration_checkbox_9f62f14202e0d2f112466524ac8f8bc9' aria-label='I declare that the information provided is accurate and complete to the best of my knowledge. I have read and understood Prima Nota\u2019s Conflict of Interest Policy and undertake to notify the Secretary if any changes to this declaration occur during my term.' aria-invalid='false' aria-required=true> <span>I declare that the information provided is accurate and complete to the best of my knowledge. 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