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The Policy is consistent with the ORLEN Group’s position on ethics, compliance and correctness while conducting business, “THE CORE
VALUES AND STANDARDS OF CONDUCT OF ORLEN Group”.
SCHEDULE A
ORLEN UPSTREAM CANADA LTD. (THE "CORPORATION")
COMPLIANCE AFFIRMATION
I.
Affirmation of Compliance
The undersigned certifies that he or she has received and read the above Code of Business Conduct and
Ethics applicable to all directors, officers, employees and consultants of the Corporation and agrees to
abide by the policies summarized therein.
II.
Affirmation of Legal and Ethical Business Conduct
By signing this form, the undersigned confirms that, to the best of his or her knowledge and belief, each
dealing or transaction to which he or she has been party, directly or indirectly, on behalf of this
Corporation:
1.
was characterized by honesty and integrity;
2.
complies with applicable laws and regulations;
3.
did not involve any unethical dealings, unbooked fees, special favours, benefits or contributions
to any private party, government or government agency;
4.
did not involve any unlawful arrangements with competitors; and
5.
was recorded and properly described on the Corporation's books.
If there are any exceptions, please describe them on the reverse side.
III.
Conflict of Interest Questionnaire
Please answer "Yes" or "No" to the following questions. If the answer to any question is "Yes," full
details must be given on the reverse side.
A.
Have you or, to your knowledge, has any member of your immediate family, at any time
during the period since ________
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:
1.
engaged, directly or indirectly, in any transaction for the purchase or sale of materials or other
property, or services by or to the Corporation or any subsidiary or division thereof (hereinafter
collectively called the Corporation), otherwise than in the normal capacity of director, officer or
employee of the Corporation;
Yes____
No____
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Consider what should be an appropriate date.
