Conflict of Interest Declaration Form

PEC-AD-FRM-X-15828 Rev 2

A conflict of interest arises when personal interests or involvement could impact business decisions
or activities. Employees must disclose any relationship, activity, role or position which could lead to
a conflict of interest internally or externally.
Employees are expected to recognize when they have, potentially have, or could be perceived as
having, a conflict of interest. Petrofac takes conflict of interests very seriously and every Applicant
must complete the below declaration form prior to Confirmation of Employment.

Applicant Name Date

Internal Relation or Close Personal Relationships

The applicant must make one of the following two declarations concerning any relatives or close
personal relationships who are Petrofac employees;

 I hereby declare that I do not have any relatives or close personal relationships with any
employee currently working with Petrofac

 I hereby declare that I currently have relatives or close personal relationships working for
Petrofac and who’s names and details are listed below:

Name Relationship Location of work

External Relation or Close Personal Relationships

The applicant must make one of the following two declarations concerning any relatives or close
personal relationships who are not Petrofac employees;

 I hereby declare that I do not have any relatives or close personal relationships with non-
Petrofac employees currently in a position to influence Petrofac business decisions.

 I hereby declare that I do have any relatives or close personal relationships with non-
Petrofac employees currently in a position to influence Petrofac business decisions and
who’s names and details are listed below:

Name Relationship Location of work

Applicant’s signature _________________________

Controlling Document: PEC-HR-PLM-X-15535

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 Conflict of Interest Declaration Form
PEC-AD-FRM-X-15828 Rev 2

Conflict of Interest Declaration

 I do not have any conflict of interest in connection to my employment;

 I will inform the Human Resources, without delay, of any situation constituting a conflict of
interest or could give rise to a conflict of interest;
 I have not made, and will not make, any offer of any type whatsoever from which a personal
advantage can be derived during my employment;
 I have not granted, sought, attempted to obtain or accepted and will not grant, seek, attempt
to obtain, or accept any advantage, financial or in kind, to or from any party whatsoever,
constituting an illegal or corrupt practice, either directly or indirectly, as an incentive or
reward relating to my employment;
 I understand that Human Resources reserves the right to verify this information and that I
am aware of the consequences which may derive from any false declaration in respect of
the information provided;
 I understand that should a conflict of interest exists which is deemed to be of a serious
nature, my employment application may be rejected.

If applicable, declare existing/potential conflict of interest situations arising from your employment
with Petrofac;

I declare that the above details are correct to the best of my knowledge and am aware of my
responsibilities to take reasonable steps to avoid any real or apparent conflict of interest in
connection with my employment and to advise my manager and HR department of any relevant
changes in my personal circumstances.

I also declare that failure to disclose a conflict of interest may result in the termination of my
employment contract.

Applicant Name Signature Date

Note: Applicant to fill this form by hand and return the scanned copy to Human Resources by email.

Controlling Document: PEC-HR-PLM-X-15535

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