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I, the undersigned, ...................................., declare that I have taken note of Article 11(1) of Regulation (EU, Euratom) No 1141/2014 of the European Parliament and of the Council on the statute and funding of European political parties and European political foundations and will exercise my duties as member of the committee of independent eminent persons in full independence and in full compliance with the rules of that Regulation.
I will neither seek nor take instructions from any institution or government, or from any other body, office or agency. I will refrain from any act which is incompatible with the nature of my duties.
I declare, to the best of my knowledge, that I am not in a situation of conflict of interests. A conflict of interests exists where the impartial and objective exercise of my duties as member of the committee of independent eminent persons is compromised for reasons involving family, personal life, political, national, philosophical or religious affinity, economic interest or any other shared interest with a recipient.
In particular, I declare that I am not a member of the European Parliament, the Council or the Commission. I do not hold any electoral mandate. I am not an official or other servant of the European Union. I am not, and never have been, an employee of a European political party or of a European political foundation.
Done at …,
[DATE + SIGNATURE
of the designated member
of the committe
of independent eminent persons]