Submit a Request to Provide a Gift

Complete the questions below to request approval to provide a gift to an HCP, Government Official, or an employee of a current or potential customer. As a reminder, approval is only required when a gift exceeds applicable Country Limits for the country where the gift will be provided.

Purpose

Is the gift an approved item of medical utility? (Click the informational icon for a list of approved items.)
Yes
No
Is the gift being provided to commemorate a significant national, cultural or religious event, or a significant company commercial ceremony, such as a facility launch?
Yes
No
Is the gift required under a written agreement?
Yes
No
Is the gift being provided in order to offer anyone an incentive or reward for granting the company business, favorable treatment, or any other commercial benefits?
Yes
No
Has any formal or informal "return on investment" or "ROI" analysis been conducted with respect to providing the gift and any resulting commercial benefit for the company?
Yes
No
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Nature and Appearance

Please select the country where the gift will be provided.
Did any proposed recipient select the gift?
Yes
No
Is the gift in the form of, or offered to provide or support, any of the following:
  • Tickets to, or attendance at, a sporting or entertainment event?
  • Providing recipients with any cash or cash equivalents (e.g., gift certificates or gift cards, shopping money, “pocket money,” “walking around money,” “per diems,” bitcoins or other crypto-currencies, or “points” that can be redeemed for items of personal use)?
  • Any personal expenses, such as housing or household costs (e.g., rent, down payments, furniture, utilities, cell-phone bills, or car payments), office renovations or equipment,  security or transportation services (e.g., guards or chauffeurs), personal medical care, shopping, or country club membership, golf-green fees, or support for other hobbies, classes or lessons?
  • Personal travel, leisure, tourist, or sightseeing activities (e.g., trip to visit a relative, a honeymoon, birthday trip, religious trip, or other personal or tourist vacation, skiing or golfing trips or access to a company golf-club membership or timeshare, or a trip to a sporting event (e.g., World Cup, Super Bowl or Olympics))?
  • Any activities that could be considered inappropriate, such as gambling or adult entertainment?
  • Any other expenses that violate company policies?
Yes
No
Would you hesitate or refrain from providing the gift if the media, competitors, or the public became aware of it, or criticize a competitor for providing the same or something similar?
Yes
No
Does your offering or providing the gift comply with all applicable laws or regulations, including any regulations imposed by the employer of the recipient, such as site rules or notification requirements?
Yes
No
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The Recipient(s)

What is the recipient's home country?
Is he or she a government official?
Yes
No
Is he or she an HCP?
Yes
No
Is he or she an employee of a current or potential customer?
Yes
No
Does he or she have any influence over the company’s business over the next 12 months besides prescribing the company's product (e.g., awarding a tender, contract or sale, securing regulatory or other governmental action, etc.)?
Yes
No
Who identified him or her as a recipient?
Will the recipient receive anything that is additional to, or different from, what is provided to any other recipients?
Yes
No
Add Another Recipient

Recipient(s) Added

John Doe, CEO, Acme Inc.
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Will the gift be provided to, or for the benefit of, a spouse or relative of an HCP, government official, or employee of a current or potential customer, who would not otherwise independently qualify to receive the gift (e.g., as an HCP for whom the gift is appropriate)?
Yes
No
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Structure

Have communications or financial transactions around the transaction been conducted, or are they planned to be conducted, in a manner that is secretive or not transparent? (Click the information icon for specific examples.)
Yes
No
Have communications around the transaction used any suspicious or vague code words that that do not sufficiently or accurately describe the nature of the expense or suggest that the transaction may not be appropriate (click the information icon for specific examples)?
Yes
No
Will the gift be provided or reimbursed in any of the following ways:
  • Using money from off-the-books accounts, third-party accounts, or personal accounts of employees, or “cash desks” or “cash safes”?
  • By reimbursing employees outside of the ordinary reimbursement process for such expenses?
  • By reimbursing expenses without invoices or receipts?
  • By paying expenses directly to a government official or employee of a current or potential customer, or to a travel agency or other third party selected by those individuals?
  • In any manner different than the company's ordinary financial or approval processes or in any other way that differs from how similar expenses would be paid or reimbursed (click the information icon for specific examples)?
Yes
No
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Additional Information

Select a file to Upload

Uploaded Files

Request Letter
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