DECLARATION & CONFLICT OF INTEREST FORM FOR EMPLOYEES

ANNUAL ACKNOWLEDGMENT AND CERTIFICATION BY EMPLOYEES

In compliance with the Code of Conduct, all Employees are required to annually complete this Code of Conduct Declaration. Employees are also required by law to declare any conflict of interest.

You are advised to carefully read this Declaration before signing.

You are further advised to contact Yetunde Ayeni on Yetunde.Ayeni@heirslifeassurance.com or Blessing Ezemelue on blessing.ezemelue@heirsinsurance.com if you require clarification on any aspect of this Declaration.

I hereby confirm that I have received, read, understood and agree to abide by the Code of Conduct (‘’Code’) of Heirs Life Assurance Limited.
I undertake to comply with the Code including any additions, amendments or replacement which may be made from time to time throughout the period of engagement with Heirs Life Assurance Limited.

I understand that I am responsible for the implementation of and compliance with the Code in carrying out my duties as an employee.

I understand that any violation or breach of the Code can result in consequential action including but not limited to the termination of my contract of employment.

Confidentiality & Privacy

I understand that all information I receive in the course of my engagement as a member of staff is confidential and such information shall not be disclosed save to carry out my duties and responsibilities.
I understand that I must take care to protect private information of fellow employees, directors and third parties that come within my possession in the course of my engagement as a member of staff from inappropriate or unauthorised use or disclosure.

Conflict of Interest:

I understand that I am to declare any conflict of interest I may have in this form or at any point in time when such conflict arises during the course of the year.

Please describe below any relationships, transactions, positions you hold (volunteer or otherwise), or circumstances you believe could contribute to a conflict of interest between carrying out your duties with Heirs Life Assurance Limited and your personal interests, financial or otherwise:

Choose One

I have no conflict of interest to reportI have the following conflict of interest to report

1. Other Interests/Directorships:

Please provide details of interests or other directorships you currently hold in any of the following companies;

i. Reinsurance Company

ii. Insurance Company

iii. Takaful Insurance Company

iv. Microinsurance Company

v. Insurance Broking Firm

vi. Loss Adjusting Company

vii. Actuarial Firm

viii. Accounting / Taxation Firm/ Audit Firm

ix. Legal & Secretarial Firm (collectively, the “Listed Entities”)

Name of company 1:

Date appointed 1:

Role on Board 1:

Tenure on Board 1:

Name of company 2:

Date appointed 2:

Role on Board 2:

Tenure on Board 2:

Name of company 3:

Date appointed 3:

Role on Board 3:

Tenure on Board 3:

Name of company 4:

Date appointed 4:

Role on Board 4:

Tenure on Board 4:

Name of company 5:

Date appointed 5:

Role on Board 5:

Tenure on Board 5:

2. Shareholding:

Please confirm the number of shares held in any of the Listed Entities in section 1 above:

2.1 Direct Shareholding

Name of Company 1:

Shareholding 1:

Name of Company 2:

Shareholding 2:

Name of Company 3:

Shareholding 3:

Name of Company 4:

Shareholding 4:

Name of Company 5:

Shareholding 5:

2.1 Indirect Shareholding

Name of Company 1:

Name of Shareholder 1:

Shareholding 1:

Name of Company 2:

Name of Shareholder 2:

Shareholding 2:

Name of Company 3:

Name of Shareholder 3:

Shareholding 3:

Name of Company 4:

Name of Shareholder 4:

Shareholding 4:

Name of Company 5:

Name of Shareholder 5:

Shareholding 5:

3. Other interests to Declare

Signature

Name

Date