[Rt4-whois] Regarding statements of Interest

[Liz Gasster]

All,

Once again, in the spirit of suggesting ideas to facilitate your work, below is a draft template that the GNSO has developed on Statements Of Interest for use by Working Group participants and new Council members.  It has not been officially adopted, and it will be the subject of further revision, but it is being used today.

I hope you find it helpful. It can be modified or adapted as the group sees fit.  Best, Liz


Statements of Interest  

Definition:  A written statement made by a Relevant Party that provides a declaration of interests that may affect the Relevant Party's judgment, on any matters to be considered by the Working Group.

Content: Relevant Parties shall complete a Statement of Interest as specified below:
1.	Please identify your current employer(s) and position(s).
2.	Please identify your declared country of residence, which may be the country to which you pay taxes.
3.	Please identify the type(s) of work performed at #1 above.
4.	Please list any financial relationship beyond de minimus stock ownership you may have with any company that has a financial relationship or contract with ICANN. 
5.	Are you participating in this group as a representative of any individual or entity, whether paid or unpaid?  Please answer "yes" or "no."  If the answer is "yes," please provide the name of the represented individual or entity.  
6.	Please identify any other relevant arrangements, interests, or benefits as requested in the following two questions:  
i.	Do you have any type of material interest in ICANN policy development processes and outcomes?  Please answer "yes" or "no."  If the answer is "yes," please describe the material interest in ICANN policy development processes and outcomes. 
ii.	Are there any arrangements/agreements between you and any other group, constituency or person(s) regarding your participation as a work team member?  Please answer "yes" or "no."  If the answer is "yes," please describe the arrangements/agreements and the name of the group, constituency, or person(s).