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Disclosure Statement of Financial Interest

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Presentation on theme: "Disclosure Statement of Financial Interest"— Presentation transcript:

1 Disclosure Statement of Financial Interest
Presenting Author: Institution: Country: Within the past 12 months preceding this Congress, I have had a financial interest/arrangement or affiliation with the organisation(s) listed below. Affiliation/Financial Relationship Company Grant/Research Support Consulting Fees/Honoraria Major Stock Shareholder/Equity Royalty Income Ownership/Founder Intellectual Property Rights Other Financial Benefit Company One Company Two Company Three Company Four Company Five Company Six Company Seven

2 Disclosure Statement of Financial Interest
I, (insert name) DO NOT have a financial interest/arrangement or affiliation with one or more organisations which could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.


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