Integrity Declaration Form

Suppliers use this declaration to confirm their standing under procurement integrity rules, listing any charges or convictions involving the company, its affiliates or its major shareholders. Procurement officers receive a signed, dated record ready for the bid file.

Use this template

In the Claude connectors directory

Page 1

Supplier's legal name

First Name

Last Name

Supplier's address

Street Address

City

State / Province

ZIP / Postal Code

Supplier's procurement business number (PBN)

Date of the bid or closing date of the invitation

Page 2

Name of the party with a charge or conviction

Relationship of that party to the supplier

Foreign country and jurisdiction where it occurred

Indicate whether it is a charge or a conviction

Date of the charge or conviction

Additional comments

Page 3

If you cannot certify the full list of foreign charges and convictions from the past three years, indicate how you will provide the explanation

The explanation is attached to this form Not applicable: I can certify the full list I will provide the explanation separately

Page 4

Name of the signatory

Phone number

Email

Date

Signature

Sign here

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