Implementation Advisory Group for Competition, Consumer Trust & Consumer Choice (IAG-CCT)

Statement of Interest

  1. Your Name:

  1. Current vocation, employer and position:

  1. Type of work performed in #2 above and declaration of relationship with entities holding a Financial (or declarable) Interest in ICANN:

  1. Identify any financial ownership or senior management/leadership interest in registries, registrars or other firms that are interested parties in ICANN policy or any entity with which ICANN has a transaction, contract, or other arrangement:

  1. Are you, or a company you work for:
    1. Currently an applicant for a new gTLD?
    2. Providing advice to any current or future new gTLD applicants?
    3. Otherwise involved in an application submitted for the New gTLD Program, such as providing service in support of an applicant or having a financial interest in an applicant?

 

  1. Yes       No

 

  1. Yes       No

 

  1. Yes       No

 

  1. If your answer is “yes” to any questions in #5 above, please identify the interest you have in the application submitted for the New gTLD Program.

  1. Identify any type of commercial interest in ICANN policy development outcomes. Do you represent other parties in any PDP or other ICANN related processes?

  1. Are you participating in the IAG-CCT as a representative of any individual or entity, whether paid or unpaid? 

Yes       No

  1. If your answer is “yes” to #8 above, please provide the name of the represented individual or entity.

  1. Do you have any type of material interest in the outcomes of the work of the IAG-CCT? 

Yes       No

  1. If your answer is “yes” to #10, please describe that material interest.

  1. Are there any arrangements/agreements between you and any other group, constituency or persons(s) regarding your participation on the IAG-CCT? 

Yes       No

  1. If your answer is “yes” to #12, please describe the arrangement and with whom it is entered.

  1. Geographic Region associated with the nationality of volunteer (Africa, North America, Latin America/Caribbean, Asia/Australia/Pacific and Europe):

  1. Stakeholder Group (you may enter up to five):

Except as described above, I have no (i) ownership or investment interest in any entity with which ICANN has an existing or proposed transaction, contract, dispute, or other arrangement; (ii) a compensation arrangement with any entity or individual with which ICANN has a transaction, contract, dispute, or other arrangement; and (iii) a potential ownership or investment interest in, or compensation arrangement with, any entity or individual with which ICANN is negotiating a transaction, contract, dispute, or other arrangement.

 

                                                                                                            

Signature

 

17 October 2019                            

Date