Conflict of Interest Statement and Form

I have read the statement of policy regarding conflicts of interest. To the best of my knowledge and belief, except as disclosed herewith neither I nor any person with whom I have or had a personal or business relationship is engaged in any transaction or activity or has a relationship that may represent a potential competing or conflict interest, as defined in the statement of policy. Further, to the best of my knowledge and belief, except as disclosed herewith, neither I nor any person with whom I have or had a personal business, or compensate professional relationship intends to engage in any transaction, to acquire any interest in any organization or entity, to become the recipient of any substantial gifts or favors that might be covered by the statement of policy regarding conflicts of interest.