Membership*
I Dr *
Member / Office Bearer on the National Executive Committee of the Indian Society of Critical Care Medicine (ISCCM), Mumbai
* *    
have read the Principles and Policies of the ISCCM with regards to conduct, commitment and conflict of interest.
I concur, without exception, with the ethical premises underlying these Principles and Policies
I place my commitment to the ISCCM and to the advancement of its goals s and will execute my responsibilities as a Member/ Office Bearer on the
National Executive:
  • Maintaining the highest level of ethical behaviour
  • Avoiding personal gain from this position both while serving on the Executive Committee and after the expiry of my term
  • Maintaining the greatest level of confidentiality about all maters related to the ISCCM that I have learnt as a result of my position on the Executive Committee
I pledge to maintain transparency in my dealings with organizations or individuals having an association or transactions with the ISCCM and will honestly disclose any conflicts that may arise as a consequence of my relationship with these entities.
  If I am judged to violate any of these principles or policies, I will abide by the rulings of the President and Executive Committee of the ISCCM.
Date *: Address *:

Appendix 2
Disclosure of Conflict of Interest:
I Dr*
Member / Office Bearer on the National Executive Committee of the Indian Society of Critical Care Medicine (ISCCM), Mumbai
*    
have read the Principles and Policies of the ISCCM with regards to conflict of interest.
I understand that no member of the EC shall derive any personal profit or gain, directly or indirectly, by reason of his or her position on the ISCCM. I therefore declare below my personal interests and professional associations that may result in a conflict of interest with the ISCCM.
I: At this time, I am a board member, a committee member, or employee of the following
Organization : Post :
II a: I also attest to the fact that currently, or in the past year, I have not been a participant, directly or indirectly, in any arrangement, agreement, investment, or other activity with any vendor, supplier, or other party; doing business with the ISCCM which has resulted or could result in personal benefit to me.
II b: I, my department or my institution have also not been a recipient, directly or indirectly, of any salary payments, loans, any free service, discounts or other fees from or on behalf of any person or organization engaged in any transaction with the ISCCM
Stated below are exceptions to clause II a & II b (Full description of the transactions / interests, whether direct or indirect, which you (including your Department or Institution) have (or have had during the past year) in organizations or individuals having transactions with the ISCCM).
I assure the EC that I will continue to update these lists if and when I recognize future situations, appointments or relationships that would engender potential conflicts and jeopardize the name, status, prestige, goals or other interests of the ISCCM.
Date *: City *:
I have read and agree to the above Undertaking
Printed Name :