Comprehensive Disclosure Form for High-Value Gifts, Travel & Entertainment from External Parties

Employee Full Name

Employee ID Number

Job Title

Department/Business Unit

Direct Manager's Full Name

Employee Corporate Email Address

Employee Contact Phone Number

Primary Work Location/Office

Length of Service at Company (in years)

Is this your first disclosure submission?

Do you have financial signing authority or procurement decision-making power?

What is your level of involvement in procurement or vendor management?

External Party Primary Contact Full Name

External Party Organization Legal Name

Organization Type

Organization Industry Sector

Relationship Duration with Organization

Nature of Current Business Relationship (select all that apply)

Approximate Annual Contract Value (if applicable)

Is this organization classified as a strategic account?

Have you received any gifts, travel, or entertainment from this party in the last 12 months?

Have you given any gifts, travel, or entertainment to this party in the last 12 months?

Do you have any personal relationship (friendship, family, former colleague) with any representative of this organization?

Are there any family members employed by or serving on the board of this organization?

Type of Disclosure

Status of the Gift/Travel/Entertainment

Date the gift/travel/entertainment was offered

Date the gift/travel/entertainment was received/accepted (if different)

Time of event (if applicable)

Location/Venue Name

Was this a group event involving multiple employees?

Number of external party representatives involved

Have you attached supporting documentation (receipts, invitations, itineraries)?

Can you provide visual documentation (photos, screenshots)?

Was alcohol served or consumed during this event?

Did this occur during a recognized holiday season or cultural celebration?

Describe the business context in which this was offered (meeting, conference, unsolicited, etc.):

Do you believe this gift/travel/entertainment could create an actual or perceived conflict of interest?

Rate the following risk dimensions

Are you aware of any pending decisions, contracts, or evaluations involving this party?

Does this gift/travel/entertainment comply with your understanding of company ethics policy?

Have you consulted the written Corporate Ethics & Anti-Corruption Policy?

Are you aware of any applicable laws or regulations that might prohibit or restrict this?

What is the monetary threshold requiring disclosure in your company's policy?

Does the estimated value exceed your company's disclosure threshold?

What alternatives to acceptance did you consider? (select all that apply)

Rank your primary reasons for accepting this exchange (1 = most important)

Provide comprehensive business justification for accepting this gift/travel/entertainment:

Was there any explicit or implicit expectation of reciprocity or favorable treatment?

Is this type of exchange customary and accepted practice in your industry?

Would you be comfortable if details of this exchange were made public or reported to media?

Have you discussed this matter with your peers or colleagues for perspective?

Overall risk assessment: Rate the compliance risk level of this exchange (1 = Minimal Risk, 5 = Critical Risk)

Propose specific mitigation measures to address any identified risks:

Primary Reviewing Manager Name

Manager's Corporate Email

Recommended Approval Authority Level

Has your manager been notified verbally about this disclosure?

Supporting Documents Attached (check all that apply)

Priority Level for Review

Requested Review Completion Date

Additional Comments for Reviewers:

Employee Digital Signature - By signing, I certify that all information provided is truthful and accurate to the best of my knowledge.

Submission Date