Conflict of Interest Disclosure by dara1111


									Conflict of Interest Disclosure

WHEREAS, I, _________________________, am a member of the Board of Directors of
_________________________, and, WHEREAS, the Board of Directors of
________________________ will consider the following issue: _________________________,
and, WHEREAS, I have a conflict of interest in that, _________________________, I herewith
notify the board of such conflict, and recuse myself from the consideration and discussion of
_________________________, and request that this disclosure be made a part of the records of
the _________________________ Corporation.

Dated: ______________________


Receipt of this instrument is acknowledged on ________________________:

Corporate secretary of _________________________

Conflict of Interest Disclosure
Review List
This review list is provided to inform you about this document in question and assist you in its
preparation. It is extremely important that you follow the niceties of corporate governance and
make sure any party with a conflict of interest properly recuses him or herself and records it on
the record in the corporate minutes. This protects the individual, the Board, and the Company
from certain negative consequences in a shareholder lawsuit.

1. Make multiple copies. File one in the corporate minute book.

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