APPENDIX 1
Supplier Conflict of Interest Disclosure Form
SUPPLIER CODE OF BUSINESS CONDUCT
Policy No.: GBL-10-2021-1.0-110
SUPPLIER CONFLICT OF INTEREST DISCLOSURE FORM
VALIANT VAN SOLUTIONS INC.
Supplier Name: _____________________________________
ANGEL ROXAS
Name of Authorized Representative: _____________________________________
SALES ASSOCIATE
Position of Authorized Representative: __________________________________________
109 MUELLE DELA INDUSTRIA, SAN NICOLAS BINONDO, MANILA
Address: _________________________________________________________________
09205747763 / 09069659095
Phone No.: _______________________________________
angelito.roxas@valiantvan.com
Email: ___________________________________________
It is ICTSI’s policy to address how issues of actual, potential and perceived Conflicts of Interest involving Officers and
Employees/Consultants of ICTSI and Suppliers should be identified, disclosed and managed.
All Suppliers interested in conducting business with ICTSI must complete and return the Supplier Conflict of Interest
Disclosure Form as part of the Accreditation / Re-Accreditation requirements. Please note that all Suppliers are subject to
comply with ICTSI’s Supplier Code of Business Conduct as stated within the certification section below.
This form is designed to identify and disclose known conflicts in an effort to properly manage them.
Please refer to Annex A for the Definition of Terms.
Please complete the following questions and submit the form to the Deputized Officer (globalhradmin@ictsi.com),
with the subject “Supplier Conflict of Interest”.
1.
Are any of your company owners, directors, officers or key employee/s a Closely Related Person to an officer, director,
employee or regularly retained consultant of ICTSI?
Yes □ No □ √
If Yes, please list the name/s:
List:-
2.
Are any of your company owners, directors, officers or key employee/s a current or former ICTSI employee? Yes □
No □√
If Yes, please provide details below:
Details:-
3. Are you aware if any of ICTSI’s employee/s has/have a financial interest, direct or indirect, in your company, any of its
affiliates, owners, directors, officers or key employee/s?
Yes □ No □ √
If Yes, please list the nature of the interest and the name of the person holding the interest
List:-
4. Has an ICTSI employee accepted gifts, gratuities, lodging, dining, or entertainment, favour or anything of value from
your company, any of its affiliates, owners, directors, officers or key employee/s that might reasonably appear to
influence judgment or actions concerning your company’s business with ICTSI?
Yes  No  √
APPENDIX 1
Supplier Conflict of Interest Disclosure Form
SUPPLIER CODE OF BUSINESS CONDUCT
Policy No.: GBL-10-2021-1.0-110
If Yes, please provide details below:
Details:Please add additional pages as needed.
Your obligation with regard to the compliance to the ICTSI Supplier Code of Business Conduct, which includes Disclosure
of Conflicts of Interest, is continuous. If any material changes to the responses provided on this disclosure form occur, or
should you become aware of any potential or actual conflict following the submission of this form, the Supplier is required
to promptly update the information on this form in writing, and submit the update to the Deputized Officer.
October 4, 2023
____________________________
Date
___________________________
Signature
ANGEL ROXAS – SALES ASSOCIATE
___________________________________________________
Printed Name and Position of Authorized Representative
==================================================================
ICTSI Use Only
Reviewed by:
DEPUTIZED OFFICER
Name
Date
Checked by (Procurement):
____ Yes, named employee or official was involved in the procurement process or decision.
____ No, named employee or official was not involved in the procurement process or decision.
GLOBAL
HEAD
PROCUREMENT
Name
Remedial Action(s) to be taken:
Actions:ICTSI will follow-up on all recommended actions to ensure compliance.
Date
APPENDIX 1
Supplier Conflict of Interest Disclosure Form
SUPPLIER CODE OF BUSINESS CONDUCT
Policy No.: GBL-10-2021-1.0-110
Exceptional Review:
Global Corporate Audit &
Compliance
Name
Remedial Action(s) to be taken:
Actions:-
Date
APPENDIX 1
Supplier Conflict of Interest Disclosure Form
SUPPLIER CODE OF BUSINESS CONDUCT
Policy No.: GBL-10-2021-1.0-110
ANNEX A - DEFINITION OF TERMS:
“Closely Related Persons” are made up of “Relatives” & “Close Personal Friend(s)”.
“Relatives” include the Disclosing Party’s spouse or domestic partner, children, children by adoption, stepchildren,
parents, siblings and all other relatives, up to 4th level or degree of consanguinity (by blood) or affinity (by marriage).
Relationship by affinity shall include the relatives of the Disclosing Party’s spouse or domestic partner up to the 4th level or
degree.
“Close Personal Friend” is defined as any person with whom an Employee has a meaningful social, intimate or business
relationship outside of his/her work for ICTSI, including but not limited to co-employees, customers and business partners
with whom the Employee may have developed a relationship in the course of employment with ICTSI.