Conflict of Interest Acknowledgment

INTERNATIONAL AERIAL COMBAT SPORT FEDERATION

CONFLICT OF INTEREST ACKNOWLEDGMENT

To be completed by Directors, officers, committee members, judges, and officials before assuming a role or when a new conflict arises

IACSF-FORM-GOV-003

PART A — DECLARANT INFORMATION

Full Legal Name		Date
IACSF Role / Position		Committee / Panel (if applicable)
Member Team Affiliation (if any)		IACSF License / ID No.

PART B — UNDERSTANDING OF CONFLICT OF INTEREST

A conflict of interest exists when an individual's personal, financial, or professional interests — or those of a close associate — could impair, or appear to impair, their ability to act in the best interests of the IACSF. Examples include but are not limited to:

• Serving as a judge or official at an event in which a family member, business partner, or close personal associate is competing;

• Holding a financial interest in a Member Team, sponsor, or commercial partner over which the individual has decision-making authority;

• Being employed by, or having a contractual relationship with, an entity whose interests may conflict with IACSF decisions made by the individual;

• Having an unresolved personal dispute with a party to a matter under the individual's review or authority;

• Receiving gifts, benefits, or hospitality from a party with a matter pending before the IACSF.

PART C — CONFLICT OF INTEREST DECLARATION

Please answer all questions. If you answer Yes to any question, provide details in Part D.

Question	Yes	No
Do you have a direct financial interest (ownership, equity, employment, contract) in any Member Team, event organizer, or IACSF commercial partner?	☐ Yes	☐ No
Does a close family member (spouse, parent, sibling, child, domestic partner) have any of the above interests?	☐ Yes	☐ No
Do you have an ongoing business or professional relationship with any party currently involved in an IACSF sanctioning, disciplinary, or commercial matter?	☐ Yes	☐ No
Have you received any gift, benefit, or hospitality from a party with a pending matter before the IACSF in the past 12 months?	☐ Yes	☐ No
Are you aware of any other circumstance that could reasonably be perceived as affecting your impartiality in your IACSF role?	☐ Yes	☐ No

PART D — DETAILS OF DISCLOSED CONFLICTS

If you answered Yes to any question in Part C, describe each conflict below. Attach additional pages if needed.

Conflict Description
Parties Involved
IACSF Matters Potentially Affected
Proposed Recusal or Mitigation

☐ I have no conflicts to disclose.

PART E — RECUSAL COMMITMENT

I commit to the following:

• I will recuse myself from any deliberation, vote, decision, or official action in which a disclosed conflict is relevant;

• I will notify the Commissioner or presiding officer of a new or previously undisclosed conflict before participating in any affected matter;

• I will update this disclosure promptly if my circumstances change in any material way.

PART F — DECLARATION AND SIGNATURE

I declare that the information in this form is true and complete. I understand that failure to disclose a known conflict of interest is a breach of IACSF policy and may result in disciplinary action, including removal from my role.

Signature	Date
Printed Name	Role / Position

FOR IACSF USE ONLY

Received By
Date Received
Action Taken
File Reference

Submit to Commissioner upon assuming any IACSF role, and promptly upon discovery of any new conflict. This form supplements but does not replace the Annual COI Disclosure Statement (IACSF-FORM-GOV-004).