GIFT ACCEPTANCE & ETHICS REVIEW FORM Form Code: HSW-F34
HSWAGATA BUDDHA TOOTH RELICS PRESERVATION MUSEUM
GIFT ACCEPTANCE & ETHICS REVIEW FORM
Form Code: HSW-F34
Case Number: __________________________
Date: ____ / ____ / ______
1. GIFT DETAILS
1.1 Description of Gift:
__________________________________________
__________________________________________
1.2 Estimated Value (if known):
___________________________ (currency)
1.3 Type of Gift:
[ ] Cash
[ ] Object / equipment
[ ] Relic
[ ] Service / support
[ ] Other: ________________________________
2. DONOR DETAILS
2.1 Individual / Organization:
__________________________________________
2.2 Address:
__________________________________________
__________________________________________
2.3 Phone / Email:
__________________________________________
2.4 Any link to staff, board, or government?
[ ] Yes [ ] No
If yes, explain:
__________________________________________
3. POSSIBLE CONDITIONS OR EXPECTATIONS
Is the gift linked to any request, promise, or expectation?
[ ] Titles or honours
[ ] Special treatment
[ ] Influence on decisions
[ ] Political use
[ ] None known
Details:
__________________________________________
__________________________________________
4. ETHICAL RISK REVIEW
4.1 Conflict of interest risk:
[ ] Low [ ] Medium [ ] High
4.2 Reputation / public trust risk:
[ ] Low [ ] Medium [ ] High
4.3 Short comment on risk:
__________________________________________
__________________________________________
5. DECISION
5.1 Review Panel / Officer:
Names: ___________________________________
___________________________________
5.2 Decision:
[ ] Accept
[ ] Decline
[ ] Accept with conditions (describe):
______________________________________
______________________________________
6. SIGNATURES
Panel / Officer 1:
Name: _________________________ Signature: __________
Date: ____/____/____
Panel / Officer 2:
Name: _________________________ Signature: __________
Date: ____/____/____