Canadian Air Transport Security Authority: Schedule 4: Confidential Report

Confidential Report

Report of financial interests, Directorship activities and other interests or activities subject to disclosure in accordance with the Code of Ethics and Conduct for the Board of Directors.

Note: if space below is insufficient, attach second page

In compliance with the Code of Conduct and Ethical Behaviour for Directors, I hereby disclose the following financial interests, Directorship activities and other interests and activities, which I fully understand may have to be divested, curtailed or modified if it is determined that such assets or activities give rise to any real, apparent or perceived conflict of interest in respect of the duties and responsibilities of the position occupied by me:

Description of financial interests: 

Description of other Directorship Activities: 

Description of other Interest or Activities:

Signature: ___________________
Date:          ___________________

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The information you provide on this confidential report is collected under the provisions of the Code for the purposes of ensuring compliance and maintaining information about real, apparent or potential Conflict of Interest situations for Directors. Personal information that you provide is protected under the provisions of the Privacy Act. CATSA will only disclose personal information with your consent or as permitted by the Privacy Act or any other applicable law. For more information, please refer to CATSA's Privacy Policy.