Declaration of interest

Data submitted via this form will be handled in line with the University of Surrey's information management policies.

The University requires information about activities that may represent a conflict of interest, which could make it advantageous for an employee to put any personal considerations above the obligation to the University.

Please refer to the Ethical Conduct Procedure for further guidance.

The University does not require information about private activities which:

do not affect the impartial discharge of his/her University and Faculty or Administrative/Service Department duties
do not involve a potential conflict of interest

If in doubt, you are advised, for your own protection, to disclose.

Completion of this online form generates an email of your declaration. The email is automatically sent to secretariat@surrey.ac.uk and to you. The secretariat, in processing your declaration, will need to liaise with your line manager. You may therefore wish to forward a copy of the declaration or discuss it with your line manager so they are aware.

Personal Details

Name

University email

Staff ID number

Date

Faculty / Department

Line Manager

Any other relevant staff who should be consulted

Directors and Partners

Do you occupy a position as a Director or Partner?

Staff who hold board appointments in University Companies (one in which the University holds 50% or more of the voting shares and therefore has a majority controlling interest) need not declare this interest. Staff who hold any other board appointment must declare that interest.

Yes

Section A

Nature of Interest [Executive Director/Non-Executive Director/Partner]

Name of organisation

Address of organisation

Date of appointment/contract

Does the organisation have dealings with the University?

Yes

Don't know

Please indicate what these dealings are to the best of your knowledge

Equity Interests

Do you have equity Interests in companies that have dealings with the University or its subsidaries

Yes

(Equity interests are interests of more than 5% of the issued share capital of any company)

Section B

Company name and Companies House number

Description of security (Ordinary shares/preference shares/Options)

Number of shares acquired

Date acquired

Other interests

Do you or persons connected with you (spouse or partner, children or close relative) have any other interests that you should report? (E.g. A significant financial interest in or a contract with any company or organisation trading with the University. Colleagues must also declare paid external roles—including fellowships or appointments at other institutions—not otherwise captured by formal oversight mechanisms)

Yes

e.g. a significant financial interest in or a contract with any company or organisation trading with the University

Section C

If you have indicated yes, please provide the details of the other interest(s)

Privacy agreement

I have read and understood the University's secretariat and legal privacy notice.

Contact agreement

I am happy for the University to contact me by email with relevant information about this declaration of interest.