Gift Declaration Form - Guyana Gold Board

Date of Declaration:

Date

Time

Name of Receiver

First

Last

Position

Department

Name of the Giver:

First

Last

Giver's relationship to Gold Board:

Decision gift: of

Giver's relationship to the receiver:

Description of the Gift

Date the gift was offered:

Date

Time

Estimated Market value of the gift in GYD:

Circumstances surrounding the giving of the gift:

Circumstances surrounding the giving of the gift, including reason for giving gift (e.g., I attended to giver at the Front Desk etc.):

Did you notify your immediate supervisor or manager about the gift?

I have reviewed the circumstances surrounding the giving of the gift and is of the opinion that

It does not violate this Anti-Bribery and Anti-Corruption Policy nor any laws of Guyana.
It violates this Anti-Bribery and Anti-Corruption Policy nor any laws of Guyana.

Name of Supervisor or Manager

First

Last

Decision regarding gift:

Additional Comments