Please complete all fields marked with an astrix (*)
The information submitted will be held by Luton and Dunstable Universirty Hospital NHS Foundation Trust (L&D) for personnel or other reasons specified on this form and to comply with the organisation’s policies. This information may be held in both manual and electronic form in accordance with the Data Protection Act 1998. Information may be disclosed to third parties in accordance with the Freedom of Information Act 2000 and published in registers that L&D holds.
I confirm that the information provided above is complete and correct. I acknowledge that any changes in these declarations must be notified to L&D as soon as practicable and no later than 28 days after the interest arises. I am aware that if I do not make full, accurate and timely declarations then civil, criminal, internal disciplinary, or professional regulatory action may result.
Provide a description of the interest that is being declared. This should contain enough information to be meaningful (e.g. detailing the supplier of any gifts, hospitality, sponsorship, etc). That is, the informaiton provided should enable a reasonable person with no prior knowledge should be able to read this and understand the nature of the interest.
Types of interest:
Financial interests - This is where an individual may get direct financial benefits from the consequences of a decision they are involved in making
Non-financial professional interests - This is where an individual may obtain a non-financial professional benefit from the consequences of a decision they are involved in making, such as increasing their professional reputation or status or promoting their professional career
Non-financial personal interests - This is where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit, because of decisions they are involved in making in their professional career
Indirect interests - This is where an individual has a close association with another individual who has a financial interest, a non-financial professional interest or a non-financial personal interest who would stand to benefit from a decision they are involved in making
A benefit may arise from both a gain or avoidance of a loss.