Authorization Request for External Advisory Roles, Board Seats & Secondary Employment

Employee Full Legal Name

Employee Identification Number

Primary Department/Division

Current Job Title

Direct Manager/Supervisor Name

Employee Corporate Email Address

Employee Direct Phone Number

Current Employment Status

Original Hire Date with Company

External Business Entity Legal Name

Entity Jurisdiction of Incorporation/Registration

Entity Primary Business Activities Description

Entity Official Website URL

Nature of Proposed External Relationship

Anticipated Relationship Start Date

Expected Duration of Relationship

Have you previously engaged with this entity in any capacity?

Describe previous engagement nature, duration, and compensation:

Entity Industry Sector Classification

Entity Organizational Scale

Entity's Primary Customer Base Description

Comprehensive Description of External Duties and Responsibilities

Estimated Hours per Week Dedicated to External Role

Estimated Hours per Month

Specific Days of Week Expected for External Activities

Will any external activities occur during your regular company working hours?

Explain necessity and propose mitigation plan to ensure no impact on primary duties:

Primary Location for Performing External Work

External Entity Premises Address:

Specify hybrid arrangement details:

Describe travel requirements and destinations:

Specify other location:

Company Resources You Anticipate Using for External Work

Will you require access to company facilities for external work purposes?

Justify facility usage and specify frequency:

Does the role involve regular travel?

Detail travel frequency, destinations, and duration:

Key Deliverables, Milestones, or Project Timelines

Level of Decision-Making Authority in External Role

Will you publicly represent or speak on behalf of the external entity?

Will you interact with clients, customers, or partners of the external entity?

Describe nature of client interactions and any potential overlap with company clients:

Do you foresee any overlap between external duties and your current role responsibilities?

Detail overlapping areas and propose segregation strategy:

Is there potential for this external role to expand in scope or time commitment?

Describe potential expansion scenarios:

Is the external entity a direct competitor, potential competitor, or operating in a directly adjacent market to our company?

Explain competitive landscape overlap and specific areas of concern:

Briefly describe why no competitive concerns exist:

Does the external entity currently have, or plan to establish, any business relationship with our company?

Detail existing or proposed relationship nature, value, and key stakeholders:

Is there potential for customer base overlap between the entity and our company?

Identify overlapping customer segments and mitigation approach:

Is there potential for supplier or vendor overlap?

Identify overlapping suppliers and address any concentration risks:

Will your external role require access to our company's confidential, proprietary, or non-public information?

Specify types of confidential information and business justification for access:

Will you leverage or incorporate any company-owned intellectual property in your external duties?

Detail specific IP assets and obtainment of necessary licenses/approvals:

Could your external work generate new intellectual property that might be claimed by our company under employment agreements?

Describe IP creation potential and review relevant employment contract clauses:

Does the role pose any risk of exposure to material non-public information that could impact trading decisions?

I acknowledge that I will be subject to enhanced insider trading monitoring and blackout restrictions.

Have you been involved in any company projects or initiatives related to the external entity's business area in the past 24 months?

Describe project involvement and current status:

Data Privacy and Information Security Considerations

I have reviewed and confirm compliance with all applicable insider trading policies and confidentiality obligations.

Is a formal confidentiality or non-disclosure agreement in place with the external entity?

Upload executed confidentiality agreement:

Explain why no confidentiality agreement exists and how information will be protected:

Do you have any non-compete, non-solicitation, or exclusivity obligations in your current employment agreement that could be implicated?

Detail relevant contractual restrictions and legal review status:

Are there any public disclosure requirements (regulatory filings, transparency registers) for this external role?

Specify disclosure requirements and timeline:

Self-Assessment of Conflict of Interest Risk Factors

Estimated Annual Gross Compensation

Compensation Structure Components

Does the compensation include equity, stock options, or other ownership instruments?

Equity Compensation Details

Equity Instrument Type (if applicable)

Estimated Equity Ownership Percentage

Vesting Schedule and Conditions

Is any portion of compensation performance-based or contingent on specific outcomes?

Detail performance metrics and potential impact on objectivity:

Will you be required to recuse yourself from certain company decisions due to this external role?

Specific Areas Requiring Recusal

Are there contractual blackout periods during which you cannot engage with our company?

Specify blackout period triggers and duration:

Will you receive gifts, entertainment, or hospitality exceeding nominal value from the external entity?

Describe nature and estimated value, confirming compliance with gift policies:

Will you be reimbursed for expenses incurred in performing external duties?

Detail expense categories and approval process:

Does the external entity provide indemnification or liability protection?

Upload indemnification agreement or relevant contract clauses:

Total Estimated Annual Financial Benefit (including all forms)

Payment Frequency

Rate the financial significance of this external role relative to your primary compensation

Will you become financially dependent on this external income to meet personal obligations?

Explain circumstances and potential impact on employment decisions:

Compliance Officer Risk Assessment Summary

Proposed Mitigation Measures and Conditions

Attach Supporting Documentation

Assigned Ethics & Compliance Officer Name

Compliance Review Completion Date

Overall Compliance Risk Rating (1=Minimal, 5=Critical)

Compliance Officer Formal Recommendation

Specific Approval Conditions and Restrictions (if applicable)

Does this request require General Counsel or Chief Legal Officer review?

General Counsel Name:

General Counsel Approval Status (if applicable)

General Counsel Comments and Legal Risk Assessment (if applicable)

Final Authorization Date

Authorization Duration/Expiry

Post-Approval Monitoring Requirements

Renewal/Review Reminder Date

I, the employee, acknowledge that I have read and agree to abide by all conditions and restrictions outlined in this authorization.

Employee Digital Signature

Ethics & Compliance Lead Digital Signature

General Counsel Digital Signature (if review required)