🛡️ Independence Declaration

IIA Standard 1130 — Impairment to Independence or Objectivity

Auditor & Engagement Information

IND-2026----

Auditor Name

Auditor Email

Title / Role

Declaration Date

Engagement / Project

Audit Period

IIA Standard 1130 — Independence Questions

Answer each question honestly. Any "Yes" response requires disclosure to the CAE.

⚠️ Potential Impairment Detected

One or more responses indicate a possible impairment to independence or objectivity. You must provide details in the disclosure section below and obtain CAE approval before proceeding with the engagement.

Q1 Do you have a financial interest (direct or indirect) in the entity or area being audited?

No Yes

Q2 Have you been employed by, or had a close business relationship with, the audited entity in the past two years?

No Yes

Q3 Do you have a personal relationship (family, close friend) with key management in the audited area?

No Yes

Q4 Have you performed operational functions (designed, implemented, or operated controls) for the audited area within the past year?

No Yes

Q5 Are you aware of any other circumstances that could compromise your objectivity on this engagement?

No Yes

Q6 Have you received gifts, hospitality, or other benefits from the audited entity exceeding your organization's policy limits?

No Yes

Disclosure Details (required when any answer is Yes)

CAE has been notified and approved this declaration to proceed

Digital Signature

By signing below, I confirm that my responses are accurate and complete to the best of my knowledge, and I understand my obligation to update this declaration if circumstances change during the engagement.

Type your full name as digital signature

IIA Standard 1130 · Signed electronically on

🛡️ Independence Declaration

Auditor & Engagement Information

IIA Standard 1130 — Independence Questions

Digital Signature

Previous Declarations