Conflict of Interest Declaration

Conflict of Interest Declaration Form

In connection with my application to Hub71's program, I confirm and declare the following as of the date of this declaration;

I have no actual, potential, or perceived conflict of interest, whether personal, professional, financial or otherwise, that could reasonably compromise my application to Hub71's program.
Neither I nor, any founder, director, officer or key employee of the applicant startup has, at any time within the preceding 24 months, held or currently holds any of the following positions or engagements with Hub71:
- an employment relationship, whether full-time, part-time, or on a fixed-term basis;
- a consultancy, advisory, or contractor engagement, whether paid or unpaid;
- a board, observer, or governance role of any nature; or
- any other formal or informal engagement, arrangement, or affiliation with Hub71 or any of its subsidiaries or affiliated entities.
Neither I nor any founder, director, officer or key employee of the applicant startup has any immediate or extended family member who is currently employed by, engaged by, or otherwise affiliated with Hub71 in any capacity.
For the purposes of this declaration, "immediate family member" means a spouse, domestic partner, parent, sibling, or child, and "extended family member" means a grandparent, grandchild, aunt, uncle, niece, nephew, or first cousin.
To the extent that any matter described in paragraphs 1 or 2 above does apply, full details are set out separately in the disclosure section of the application portal.

I undertake and agree that the obligations in this declaration are not limited to the date of signing. They constitute a continuing obligation that applies throughout the duration of the application and evaluation process.
I undertake to disclose to Hub71's Startup Journey team, immediately and without delay, any matter that would cause the declarations in Part A to be inaccurate or incomplete, including any connection or affiliation that arises or comes to my attention after the date of this declaration.
Any disclosure under paragraph 2 of Part B must be made:
- in writing, via email to [email protected]
- as soon as reasonably practicable and in any event within 2 business days of the matter coming to my attention; and
- with sufficient detail to enable Hub71 to assess any implications for the applicant startup's participation in the selection process.

I am authorised to make this declaration on behalf of the company.