CONFLICT OF INTEREST DECLARATION FORM

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CUBEBEE DESIGN SDN BHD

OT-13-10, 2 RIO TOWER, PERSIARAN RIO, BANDAR PUTERI, 47100 PUCHONG, SELANGOR.

1. Employee Full Name as NRIC: *

2. Employee NRIC no: *

3. Position: *

4. Declaration

I, the undersigned, hereby declare that:

Please tick the relevant

I do not have any conflict of interest in relation to my duties and responsibilities

I have a potential/actual conflict of interest, as detailed below (fill in item 5):

5. Details of Conflict (if applicable)

Please tick the relevant

Family / Relatives involved (e.g., family member working with vendor, contractor, or customer)

Close friend or personal relationship involved (e.g., boyfriend/girlfriend, partner, housemate, best friend (e.g., boyfriend/girlfriend, partner, housemate, best friend)

Outside business interest (e.g., owning or operating a business related to the company’s activities)

Part-time job / freelance work (e.g., working for another company that may have dealings with the company)

Financial interest (e.g., shares, investments, or financial interests in a vendor, supplier, or competitor)

Decision-making conflict (e.g., involved in approving, reviewing, or influencing decisions related to someone you know)

Others (please fill in item 6 below)

Please tick the relevant

Family / Relatives involved (e.g., family member working with vendor, contractor, or customer)

Close friend or personal relationship involved (e.g., boyfriend/girlfriend, partner, housemate, best friend (e.g., boyfriend/girlfriend, partner, housemate, best friend)

Outside business interest (e.g., owning or operating a business related to the company’s activities)

Part-time job / freelance work (e.g., working for another company that may have dealings with the company)

Financial interest (e.g., shares, investments, or financial interests in a vendor, supplier, or competitor)

Decision-making conflict (e.g., involved in approving, reviewing, or influencing decisions related to someone you know)

Others (please fill in item 6 below)

6. For others:

Please specify in details of the potential conflict:

7. Actions Taken or Proposed to Manage the Conflict (if any)

Column 1

No action taken yet

I have informed my immediate superior/manager/HOD

I have removed myself from the related decision-making

I propose reassignment of the task or responsibility

Other action taken/proposed: (please fill in the item 8)

8. For others:

Please specify Other action taken/proposed:

9. Employee Declaration Statement (Mandatory)

• The information provided in this declaration is true, complete, and accurate to the best of my knowledge.

• I undertake to update this declaration if any situation arises that may constitute a conflict of interest.

• I understand that failure to disclose a conflict of interest may result in disciplinary action.

Required

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