Declaration of Interests for WHO Experts
6d Have your received any payments (other than for travel costs) or honoraria for speaking
publicly on the subject of this WHO meeting or work?
Yes
No
6e Is there any other aspect of your bac kground or present circu mstances not addressed
above that might be perceived as affecting your objectivity or independence? Yes
No
7.
TOBACCO OR TOBACCO PR ODUCTS (answer without regard to relevance to the
subject of the meeting or work)
Within the past 4 years, have you had employment or received research support or other
funding from, or had any other professional relationship with, an entity directly involved
in the production, manufacture, distribution or sale of tobacco or tobacco products or
representing the interests of any such entity? Yes
No
EXPLANATION OF "YES" RESPONSES: If the answer to any of the above questions is "yes", check
above and briefly describe the circumstances on this page. If you do not describe the n ature of an interest or
if you do not provide the amount or value involved where relevant, the conflict will be assumed to be
significant.
Nos. 1 - 4:
Type of interest, question
number and category (e.g.,
Intellectual Property 4.a
copyrights) and
basic
descriptive details.
Name of
company,
organization, or
institution
Belongs to you, a
family member,
employer, research
unit or other?
Amount of income
or value of interest
(if not disclosed, is
assumed to be
significant)
Current
interest (or
year ceased)
Nos. 5-6: Describe the subject, specific circumstances, parties involved, time frame and other relevant details
CONSENT TO DISCLOSURE
. By completing and signing this form, you consent to the disclosure of any
relevant conflicts to other meeting participants and in the resulting report or work product.
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