Declaration of Interests for WHO Experts
EMPLOYMENT AND CONSULTING
Within the past 4 years, have you received remuneration from a commercial entity or
other organization with an interest related to the subject of the meeting or work?
1a Employment Yes
No
1b Consulting, including service as a technical or other advisor Yes
No
RESEARCH SUPPORT
Within the past 4 years, have you or has your research unit received support from a
commercial entity or other organization with an interest related to the subject of the
meeting or work?
2a Research support, including grants, collaborations, sponsorships, and other funding Yes
No
2b Non-monetary support valued at more than US $1000 overall (include equipment,
facilities, research assistant s, paid travel to meetings, etc.)
Support (including honoraria) for being on a speakers bureau, giving speeches or training
for a commercial entity or other organization with an interest related to the subject of the
meeting or work?
Yes
No
INVESTME NT INTERESTS
Do you have current investments (valued at more than US $10 000 overall) in a
commercial entity with an interest related to the subject of the meeting or work? Please
also include indirect investments su ch as a trust or holding company. You may
exclude mutual funds, pension funds or similar investments that are broadly diversified
and on which you exercise no control.
3a Stocks, bonds, stock options, other securities (e.g., short sales) Yes
No
3b Commercial business interests (e.g., proprietorships, partnerships, joint ventures, board
memberships, controlling interest in a company) Yes
No
INTELLECTUAL PROPERTY
Do you have any intellectual property rights that might be enhanced or diminished by
the outcome of the meeting or work?
4a Patents, trademarks, or copyrights (including pending applications) Yes
No
4b Proprietary know-how in a substance, technology or process Yes
No
PUBLIC STATEMENTS AND POSITIONS (during the past 3 y ears)
5a As part of a regulatory, legislative or judicial process, have you provided an expert
opinion or testimony, related to the subject of the meeting or work,
for a commercial entity or other organization?
Yes
No
5b Have you held an office or other position, paid or unpaid, where you represented interests
or defended a position related to the subject of the meeting or work? Yes
No
ADDITIONAL INFORMATION
6a If not already disclosed above, have you worked for the competitor of a product that is the
subject of the meeting or work, or will your participation in the meeting or work enable
you to obtain access to a competitor's confidential proprietary information, or create for
you a personal, professional, financial or business competitive advantage? Yes
No
6b To your knowledge, would the outcome of the meeting or work benefit or adversely
affect interests of others with whom yo u have substantial common personal, professional,
financial or business interests (such as y our adult children or siblings, close professional
colleagues, administrative unit or department)? Yes
No
6c Excluding WHO, has any person or entity paid or contributed towards your travel costs in
connection with this WHO meeting or work? Yes
No
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