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Annual Conflicts of Interest Statement
Electric Insurance Company and Affiliate's Directors and Officers DO NOT need to complete this form as they have received a separate Conflicts of Interest Questionnaire. (Directors are those individuals who sit on the Electric Insurance and/or affiliate's Board).
It is each Associate's responsibility to review the Electric Insurance Policy on Conflicts of Interest in its entirety, which can be found on the Electric Insurance Intranet.
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- Conflicts of Interest Affirmation
I have read Electric Insurance Company’s Policy on Conflicts of Interest. I have reviewed my affairs and hereby certify that I am in compliance with such Policy and I have no knowledge of any potential violations thereof except as specifically disclosed below or disclosed previously to Electric Insurance Company’s General Counsel.
In addition, by signing this letter, I represent that I have, at least annually, made sure that all Associates under my direct supervision are aware of the aforementioned policies.
Please Describe Any Disclosures: *
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- By checking "yes" and adding your name (Associate's Name) you are electronically signing and agreeing to the above statements:*
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- Associate's Name (Last, First):*
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- Cognizant VP: *
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- Please enter today's date:*
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