Instructions: Kindly complete this form in BLOCK LETTERS. Sign at the bottom of the form. Please write legibly.

CONFLICT OF INTEREST COMPLIANCE QUESTIONNAIRE

To be accomplished by the employee:

Employee No. Name (Last, First, Middle) Group/Department Date

Please answer the following questions to the best of your knowledge and check the appropriate box.
CONCERNS/ISSUES YES NO/NONE
1. My immediate family and/or I have financial interest in a non-publicly owned
enterprise which deals or transacts business with the Company.
Details:

2. I have relative/s up to the 4th degree of consanguinity or affinity in the Company.

Details:

3. I have all relative/s up to the 4th degree of consanguinity or affinity employed by

our competitors.
Details:

4. I am engaged in the private practice of my profession.

Details:

5. I have personal or familial relations with someone whom I have to transact

business with for the Company which may give rise to an appearance of my
actions/decisions being influenced by such relationship.
Details:

Declaration:
I hereby authorize MWCI to collect, use, process, store, retain, and dispose the above personal, sensitive, and confidential data, covered under
the provisions of Republic Act No. 10173 or the Data Privacy Act of 2012 for the purpose of recruitment and/or processing and employment
record keeping.

I certify that all information herein are true and correct to the best of my knowledge and belief. I understand that any misrepresentation or
false information contained herein shall be considered sufficient cause for cancellation of my application or ground for the termination of my
employment.
Noted By:

EMPLOYEE IMMEDIATE SUPERVISOR

(Signature Over Printed Name) (Signature Over Printed Name)