Conflict of Interest Disclosure Questionnaire

Habitat for Humanity Ireland conducts its business with the highest degree of ethical standards. Members of the Board and Habitat managers are expected to model ethical behaviour in their leadership and business transactions on behalf of Habitat. This Conflict of Interest Disclosure Questionnaire is designed to elicit information from Board members and managers to assure they are acting in the best interest of Habitat and to identify any conflicts of interest they may have.

A conflict of interest may occur where volunteers or employees have a financial, business, or personal interest that is in conflict or appears to be in conflict with the interests of Habitat.

Immediate disclosure of conflicts of interest is an essential obligation. Habitat has a structured conflict of interest process with the following steps:

(1) Board members or managers must identify or recognise their financial, business, and personal interests in conflict with the interests of Habitat;

(2) they must next disclose the conflict to the Chairperson of the Board and CEO, respectively;

(3) the Chairperson and CEO will assess any impact of the conflict on Habitat;

(4) the Chairperson and CEO will discuss possible remedial actions with the Board member or manager. Remedial actions may range from firewalls in the manager’s work, to exclusion from a Board vote, business decision or transaction involving Habitat or another organisation, to withdrawal from the other organisation’s business or board of directors, to other actions that eliminate the conflict of interest or appearance of a conflict.

In completing the Questionnaire, please note that the term “immediate family members” includes a person’s spouse, parents, children (including adopted), siblings, mothers and fathers-in-law, sons and daughters-in-law, brothers and sisters-in-law, grandparents, spouses of siblings or children, or domestic partner, or anyone who shares such person’s home.

Personal Details

First Name

Surname

Employment by Habitat

Do you have an immediate family member who is now employed by Habitat?

If yes, please identify the person, position and date of such employment by Habitat.

Personal Renumeration from Habitat

Are you or any of your immediate family members receiving or expecting to receive any renumeration from Habitat other than employment compensation?

If yes, please identify the person, position, amount and date the renumeration is expected to be received.

Business with Habitat

Do you have a financial or business interest in a business or organisation with which Habitat does business or received payments for property, goods or services?

Have you been a party to or involved in a contractual transaction with Habitat?

Do you have an immediate family member who has a financial or business interest in a business or organisation with which Habitat does business or received payments for property, goods or services?

If yes, please identify: (a) your financial, business, contractual or organisational interest; (b) the relationship between Habitat and the other business; (c) if an immediate family member has the interest, identify the relationship of the person to you; and (d) the impact on the interest of Habitat or the other business

Other Commitments

Please list all companies, organisations, or institutions on whose board of directors, board of trustees, or other governing bodies, or advisory boards you currently serve. Please identify the nature of the organisation’s business, and whether that organisation does business or is involved in litigation with Habitat. Attach additional pages to this questionnaire as needed to reflect all boards and governing bodies

Association with Habitat Auditors

The auditor for Habitat is currently Goldblatt McGuigan. Are you, or an immediate family member, a partner or principal in Goldblatt McGuigan?
Identify any immediate family members who are employees of Goldblatt McGuigan, and who participate in the audit, assurance, or tax compliance practice for Habitat.

Political Parties

Please detail if you have any association/affiliation with any political party

Legal Proceedings

Are there any legal proceedings adverse to Habitat pending or anticipated in which you, an immediate family member, or any entity listed by you in response to the above questions are a party?

If yes, please list them below

During the past five years have you been convicted in a criminal proceeding or are you now the named subject of a pending criminal proceeding (excluding traffic violations and other minor offenses)?

If yes, please provide the details below

Other

Is there anything that has not been asked in the Questionnaire that you believe Habitat should know, eg previously employed by a competitor of Habitat or previously on the Board of a competitor? If Yes, please provide the details below

Declaration

Signature (Please type full name to confirm submission)

Date

Thank You

Thank you for completing the Habitat Ireland Conflict of Interest Disclosure Questionnaire.
If you have any questions or require clarification, please contact the Operations Director Fancea McNally at fanceam@habitatireland.org . This Questionnaire is to be completed annually, however any relevant change must be notified throughout the year.

Contact Information