HCC Conflict of Interest Disclosure Statement/Affidavit - hccfl 2026

1. Click ‘Get Form’ to open the HCC Conflict of Interest Disclosure Statement/Affidavit in the editor.
2. Begin by entering your legal name and position/title as the authorized representative in the designated fields.
3. Fill in the legal name of your business entity along with its principal mailing address, including street number, city, state, and ZIP code.
4. Provide your Federal Employer Identification Number (FEIN) and Taxpayer Identification Number (TIN) accurately.
5. In the disclosure section, indicate whether any relationships exist as outlined in items 1-3. If applicable, list details such as names, positions, relationships, and ownership percentages.
6. Finally, ensure you sign and date the affidavit at the bottom to certify that all information is true and accurate.

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