Appendices

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Appendix 15. Sample Anti-Corruption Certification for Expense Reports

Anti-Corruption Questions

Answers

Have you reviewed all expenses submitted? 

[ ] Yes

[ ] No

Were all expenses submitted according to policies and procedures? 

[ ] Yes

[ ] No

If no, please explain:

Were any exceptions approved by Senior Leader?  [ ] Yes. [ ] No

Approver:

If no, please explain reason for submission of expenses:

Were any expenses related to Foreign Officials?                                                                           

[ ] Yes

[ ] No

If Yes, please provide specific details:

  • Anything of value, including money, gifts, gratuities, meals, lodging, entertainment, and any other thing of value, whether made directly or indirectly, to a "Foreign Official?

  • Any giving through a third party, such as a local agent, consultant, attorney, or subsidiary?

  • Any giving related to state officials/government agents, etc.?

Please certify that the above is accurate to the best of your knowledge:

Name: __________________________________________________________

Date: ___________________________________________________________

Title: ___________________________________________________________

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