TK-049 (C/E) Template Title: External Expert Conflicts of Interest — Funding Links & COI Disclosure Form

 THE HSWAGATA BUDDHA TOOTH RELIC PRESERVATION PRIVATE MUSEUM

FOR INTERNAL USE ONLY

Template No.: TK-049 (C/E)

Template Title: External Expert Conflicts of Interest — Funding Links & COI Disclosure Form

Related Research Case IDs / Cluster: Cluster C (Institution-Building & MoUs) + Cluster E (Science/Testing/Misinformation)

Linked Templates / Policies:

• TK-046 Scientific Testing Request & Ethics Checklist

• TK-051 Relic Testing MoU & Data Governance Sheet

• TK-027 Partner Due Diligence & Ethics Screening Form

• Institutional Policies for Relic Stewardship (HSWAGATA)

Date of form: ____ / ____ / ______

Prepared by / Role: _______________________

Office / Unit: ____________________________

Country / Location: _______________________

Confidentiality Level:
Internal only [ ] Restricted [ ] Sacred-Restricted / Sensitive [ ]

Use of this form (tick):
New case / action [ ] Follow-up [ ] Annual review [ ] Archive only [ ]

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TK-049 — Purpose

This form is used when HSWAGATA works with an external expert (scientist, conservator, historian, lab staff, media expert, or advisor).
It helps us check and record Conflicts of Interest (COI), including funding links, gifts, paid roles, and personal ties that could affect neutrality.

Goal: protect truth, protect trust, and prevent misinformation.

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A. Expert Identification

1. Full name: ______________________________________________

2. Organisation / employer: __________________________________

3. Job title / role: __________________________________________

4. Country: ____________________ City: _____________________

5. Email / phone: ___________________________________________

6. Type of expert (tick):
   ☐ Laboratory scientist ☐ Conservator ☐ Academic researcher ☐ Medical/forensic
   ☐ Heritage advisor ☐ Legal advisor ☐ Media/communications ☐ Other: __________

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B. Work Requested by HSWAGATA

1. Project / case name: _______________________________________

2. Requested service (tick):
   ☐ Advice only (no handling)
   ☐ Report writing
   ☐ Training / lecture
   ☐ Testing design
   ☐ Lab work (if approved)
   ☐ Peer review of documents
   ☐ Media interview support
   ☐ Other: __________________________________________

3. Expected output: ☐ Verbal ☐ Email note ☐ Written report ☐ Certificate ☐ Publication

4. Expected time frame: From //_____ to //_____

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C. Payment, Funding, and Benefits (Disclosure)

C1. Will you receive any payment from HSWAGATA for this work?
☐ No ☐ Yes
If yes:

• Amount / rate: __________________________

• Payment type: ☐ Fee ☐ Salary ☐ Honorarium ☐ Travel support ☐ Other: _________

C2. Will any third party pay you for this work?
☐ No ☐ Yes
If yes, name the third party and amount (if known):

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C3. Gifts / benefits (past 24 months) related to relic work
Tick any received from any party linked to this case:

• ☐ Gifts (items)

• ☐ Cash or vouchers

• ☐ Free travel / hotel

• ☐ Paid speaking invitations

• ☐ Expensive meals / entertainment

• ☐ Religious titles / honours given for support
  Details (what, from whom, when):

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D. Relationships and Interests (COI Check)

Tick Yes or No for each item. If yes, explain.

1. Do you have a personal relationship with any party in this case?
   ☐ No ☐ Yes → Explain: _________________________________________

2. Do you work for, consult for, or advise any party that may benefit from your conclusion?
   ☐ No ☐ Yes → Explain: _________________________________________

3. Do you have a business interest (company, products, services) linked to relic testing, relic trade, media promotion, or museum projects?
   ☐ No ☐ Yes → Explain: _________________________________________

4. Do you have a public position already stated about this relic or this museum (online, in media, in a publication)?
   ☐ No ☐ Yes → Explain: _________________________________________

5. Are you part of a group that is in conflict with another stakeholder (temple group, heritage group, committee, etc.)?
   ☐ No ☐ Yes → Explain: _________________________________________

6. Do you have funding links (grants, donors, sponsors) that could be affected by your report?
   ☐ No ☐ Yes → Explain (name funder + nature of link):

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7. Are you under any pressure to reach a certain conclusion?
   ☐ No ☐ Yes → Explain: _________________________________________

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E. Required Integrity Commitments (Expert Must Agree)

Tick to confirm agreement:

• ☐ I will speak truthfully and clearly about limits and uncertainty.

• ☐ I will not use “HSWAGATA” name or logo in public without written approval.

• ☐ I will not make public claims that go beyond the evidence.

• ☐ I will not accept secret payments related to this case.

• ☐ I will report any new conflict of interest if it appears later.

• ☐ I understand HSWAGATA may publish a COI summary for transparency (without private data).

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F. COI Risk Rating (HSWAGATA Office Use)

1. COI level: ☐ Low ☐ Medium ☐ High

2. Main reason (short): __________________________________________

3. Decision:
   ☐ Proceed (no limits)
   ☐ Proceed with limits (extra review / second expert / no media)
   ☐ Replace expert
   ☐ Escalate to Board / Compliance

Limits required (if any):

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Reviewer name/role: _______________________ Date: //_____

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G. Declaration and Signature (Expert)

I declare that the information above is true to the best of my knowledge.
I understand that hiding conflicts of interest can harm public trust and may end cooperation.

Expert name: __________________________
Signature: ____________________________
Date: ____ / ____ / ______

HSWAGATA witness (mandatory): __________________ Signature: __________ Date: //____

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H. Archive

Archive code / file location: ______________________________________
Status: ☐ Active ☐ Updated ☐ Archived

End of Template TK-049

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