Conflict of Interest Certificate

Complete this Certificate, including your name, signature and date and return to Amentum.
Part A - QUESTIONNAIRE Please read Amentum’s Business Partner Code of Conduct then answer each of the following questions. If you answer YES to any question, describe the actual or potential conflict of interest in detail in the field provided of this Certificate. Attach extra pages if needed. Sign and date each page.
1.	Yes No	Do you have a Family Member who works for AMENTUM? If yes, please elaborate:
2.	Yes No	Are you or is a Family Member employed, retained, or otherwise paid by an AMENTUM competitor, customer, supplier, consultant, or agent, including the federal government or a state, local or foreign government? If yes, please elaborate:
3.	Yes No	Do you or a Family Member serve as a paid or unpaid director, officer, advisor, or consultant to an AMENTUM competitor, customer, supplier, consultant, or agent? If yes, please elaborate:
4.	Yes No	Do you or a Family Member have an ownership interest in a company that is an AMENTUM competitor, customer, or supplier, or with which AMENTUM has a business relationship, or in which AMENTUM has an ownership interest, where such ownership interest: exceeds one percent of the company's publicly held securities exceeds one percent of the company's stock (or $10,000, if it is not publicly held); or represents more than 5% of your net worth Or do you have any ownership interest below these thresholds in a company whose transactions with AMENTUM are material to that company's financial results or operations? If yes, please elaborate:
5.	Yes No	Do you have any other pertinent facts or relationships (i.e., are there any marital, personal, familial, etc. relationships) which could be deemed as an Actual or Potential Conflict of Interest, given the least favorable interpretation to report that is not otherwise covered in questions 1 through 4 above? If yes, please elaborate:

Part B - CERTIFICATION I hereby certify that to the best of my knowledge the information provided in this Certificate is accurate and complete. I also certify that I have read and understand Amentum’s Business Partner Code of Conduct, will comply with it, and will make immediate written disclosure if there is any change in the information reported in this Certificate.
Signature:	Date:
Printed Name:
AMENTUM Use: Instructions for Procurement Representative If the employee answers “no” to all of the above questions, no further action is required. If the employee answers “yes” to any of the above questions, please send the completed form to the Legal Department for their review and guidance.