Please ensure you are familiar with the Trust's Managing conflicts of interest policy before making your declaration.

The information declared will be held by CHESTERFIELD ROYAL HOSPITAL NHS FOUNDATION TRUST 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 and General Data Protection Regulation. Information may be disclosed to third parties in accordance with the Freedom of Information Act 2000 and published in registers that CHESTERFIELD ROYAL HOSPITAL NHS FOUNDATION TRUST hold. 

By submitting you will be confirming that the information provided is complete and correct. Also, you acknowledge that any changes in these declarations must be notified to CHESTERFIELD ROYAL HOSPITAL NHS FOUNDATION TRUST as soon as practicable and no later than 28 days after the interest arises. And that you are aware that if you do not make full, accurate and timely declarations then civil, criminal, internal disciplinary, or professional regulatory action may result.