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Direct Engagement Due Diligence Questionaire
Direct Engagement Due Diligence Questionaire
In order to provide any payment or benefit of value, directly or indirectly, to Government Officials that will
be engaged in an activity identified as Tier 3 in the Global Heat Map, the following questions must be
completed. Unless there is reason to believe the Government Official's role has changed with the
government, this DDQ is valid for 365 days from the date it is signed.
The process for completing and approving the due diligence questionnaire shall be established locally with
input from Legal, Medical, and Compliance, with concurrence by the Managing Director, and documented
in local SOPs.
Role of the individual w ith the Government (e.g., advisor to regulatory body, decision maker on
hospital formulary board, etc.): Advisor to regulatory body
1. Does the Merck/MSD (the “Company”) have any pending or anticipated business which the
identified Government Official based on his/her responsibility or involvement with the government
would have an involvement in or influence on (whether regulatory, procurement or any other
discretionary decision) our business:
Yes No
If yes, provide additional details about the pending business and the role of the
Government Official:
2. Was this individual involved in any decisions regarding Merck/MSD products over the past 4-6
months?
Yes No
Will this individual be involved in any decisions regarding Merck/MSD products in the coming 6-12
months?
Yes No
If yes to either question above, provide additional details about what input or decision
the Government Official was or will be involved in:
3. Does your due diligence review indicate that proceeding with payments or benefits to the intended
recipient is consistent with the Company policy and standards for interactions with government
employees and officials, and will not result in improper influence, give the Company improper
competitive advantage, or create an appearance of impropriety even with a payment or benefit is
appropriate?
Yes No
EFFECTIVE DATE 17-Nov-2015 GMT-0500
UNCONTROLLED WHEN PRINTED, SAVED, DOWNLOADED or EXPORTED
4. Is the recipient required under local law to make any disclosures, declarations or other
certifications to her/his employer, or other authority, in connection with receipt of any proposed
payment or benefit?
Yes No
If yes, please confirm and describe in sufficient detail how each such requirement has
been met by the recipient:
In accordance with Company policy, Company, Divisional or Functional Guidance, Local Standard
Operating Procedures (SOPs) and Grants of Authority, and based on the confirmations and
documentation provided above, and the necessary concurrences indicated below, the appropriate
level of Management has determined that the engagement of the abovementioned Government
Official complies with applicable Company business policies, practices and standards. Review of
each activity with this individual is required and must be evaluated based on the above
information.
Questionnaire completed and submitted for approval by the activity Business Owner or Medical
Affairs :
Date: _________________31/12/2021_________________________
APPROVED BY:
___________________________________ _________________________________
Name: Name:
Title: Title:
Date: Date: