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Annual policy acknowledgment form

A plain form for the annual director acknowledgment of a board policy (code of conduct, conflicts, confidentiality, insider trading, and similar).

When to use: Each year, and when a director joins or a policy changes.

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Policy

  • Policy name:
  • Version / date adopted:
  • Where the current copy lives:

Acknowledgment

I confirm that:

  1. I received the current version of the policy named above.
  2. I have read it and had the chance to ask questions.
  3. I will follow it, and I will tell the chair (or the person the policy names) if I have something to disclose.

Disclosures (if the policy requires any)

  • None, or describe:

Director

  • Name:
  • Date:
  • Signature or in-app acknowledgment:

For the secretary

  • Due date for this cycle:
  • Directors still owing:
  • Where acknowledgments are kept:

An acknowledgment that the policy was received is not a legal determination that anyone complied with it.

Practice template, not legal advice. Your bylaws, policies, statutes, and counsel control.

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Cite this page: Prepared Board, "Annual policy acknowledgment form," https://preparedboard.com/free-templates/policy-acknowledgment. Anchor: #cite-this. Product claims are verified on /facts.