DECLARATION OF INTEREST AND RELATION FORM

1. INSTRUCTIONS
All Bayport Staff MUST complete and submit this Form within 72 hours of being provided
with a copy of this Form.
This Form consists of Part A, Part B and Part C as follows:
i. Part A- Declaration of Interest
ii. Part B- Disclosure of a Relation
iii.Part C- Acknowledgement

2. DEFINITIONS

‘‘Conflict of Interest’’ means a situation where an individual is or maybe, in a position to

use Company information, authority or influence for personal or business gain (financial
or other) or to benefit others to the disadvantage/harm or potential disadvantage/harm to
Bayport (“the Company’’).

‘‘Disclosure’’ means the act of notifying Bayport Executive Management, in writing of

any direct or indirect financial interests and positions of influence held by an individual
which could lead to a potential, apparent or actual conflict of interest and disclosure of a
family relation such as a spouse, sibling (including a sibling to a spouse), parent
(including a parent to a spouse) or child irrespective of whether such relation is a past or
current Bayport employee.

3. PARTICULARS OF MEMBER OF STAFF

i. Name of Employee: …SAMBO SISALA………………………………

ii. Present Position: ……IT SECURITY ……

iii. Department: ……IT……………………………………………………………

iv. Branch: …………HEROES……………………………………………………………

PART A

4. DECLARATION OF INTEREST

A. BUSINESS DEALINGS WITH FAMILY MEMBERS AND FINANCIAL ASSISTANCE

SECTION 1.
I understand that if I, my family members or close relatives own businesses or are
employed in any company or institution which has business dealings (suppliers,
contractors, consultants, agents etc.) with Bayport or receive any form of financial
payments from any of Bayport’s supplier(s), contractors, consultants, agents etc., I shall Int
disclose and make a declaration to Bayport Executive Management. ern
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I, being the undersigned hereby declare that I am aware/not aware (delete whichever is
not applicable) ⃰ of any actual or potential conflict(s) of interest with respect to my
employment with Bayport.

SECTION 2. (Only Applicable to Members of Staff who have actual or potential conflict(s)
of interest)

I would like to declare the following existing/potential conflict of interest as a Bayport

Member of Staff.
Name of Persons/s Relations Name and Nature of Payment Value
business/department
where employed

B. DIRECTORSHIP, PARTNERSHIP AND MEMBERSHIP

SECTION 1.
I understand that if I, my family members or close relatives are directors of companies,
members of close corporations, or share in partnerships or joint ventures in any
organisation that Bayport has business dealings with, I shall disclose and make a
declaration to Bayport Executive Management.

I, being the undersigned hereby declare that I am aware/not aware (delete whichever is
not applicable) ⃰ of any actual or potential conflict(s) of interest with respect to my
employment with Bayport.

SECTION 2. (Only Applicable to Members of Staff who have actual or potential

conflict(s) of interest)
I would like to declare the following existing/potential conflict of interest as a Bayport
Member of Staff.
Name of Persons/s Relations Name of State whether director,
organisation member or partner

C. SHAREHOLDING AND INVESTMENTS

SECTION 1.
I understand that if I, my family members or close relatives are shareholders, or have any
other form of investment in companies that Bayport at present has dealings with, I shall
disclose and make a declaration to Bayport Executive Management.

I, being the undersigned hereby declare that I am aware/not aware (delete whichever is
not applicable) ⃰ of any actual or potential conflict(s) of interest with respect to my
employment with Bayport.

SECTION 2. (Only Applicable to Members of Staff who have actual or potential Int
conflict(s) of interest) ern
I would like to declare the following existing/potential conflict of interest as a Bayport al
Member of Staff. Inf
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 Name of Organisation/s Relations Type of Remuneration/benefits
Investment

D. PUBLIC OFFICE

SECTION 1.
I understand that if I hold any public office in a statutory body or a local authority, I shall
disclose and make a declaration to Bayport Executive Management.

I, being the undersigned hereby declare that I am aware/not aware (delete whichever is
not applicable) ⃰ of any actual or potential conflict(s) of interest with respect to my
employment with Bayport.

SECTION 2. (Only Applicable to Members of Staff who have actual or potential

conflict(s) of interest)
I would like to declare the following existing/potential conflict of interest as a Bayport
Member of Staff.
Name of Organisation/s Relations Type of work Remuneration

PART B

5. DISCLOSURE OF A RELATION

SECTION 1.
I understand that if my spouse, sibling (including a sibling to a spouse), parent (including
a parent to a spouse) or child irrespective of whether such relation is a past or current
Bayport employee, I shall disclose and make a declaration to Bayport Executive
Management.
I understand that the disclosure of a family relation as stated above shall be made prior to
commencement of employment or within 14 days of the establishment of the relation in
the event that such relation is created after the commencement of employment.

I further understand that it is a Condition of Employment that the information I furnish to

the Company including but not limited to personal details are correct in every respect and
that that I have not withheld any material details.

I understand that if any details shall be found to be incorrect or if it is discovered that I

have failed to disclose any material details, as determined by the Company, including
details relating to a relation as stated above, the Company may summarily terminate my
Employment without recourse.

I, being the undersigned hereby declare that I am aware/not aware (delete whichever is Int
not applicable) ⃰ of any relations with past or current Bayport employees. ern
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 SECTION 2. (Only Applicable to Members of Staff who have actual or potential
conflict(s) of interest)
I would like to declare the following relations with a past or current Bayport Member of
Staff.
Name of Persons/s Relation Past/Current

PART C

6. ACKNOWLEDGMENT
I, _____SAMBO SISALA_________ (full names) acknowledge that I have reviewed and
understood the contents of this Declaration Form and that the information above is true
and correct to the best of knowledge and belief. I understand and agree to provide
Bayport with an updated Declaration within 14 days of any change to the information
provided in this declaration and that failure to disclose any existing conflict of interest or
relation may lead to possible disciplinary action against me and the Company may
summarily terminate my Employment without recourse.
Date: __12/01/2024___ Signature: ____

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