SAMPLE ONLY—DO NOT USE WITHOUT CONSULTING YOUR ATTORNEY
(Copy and paste onto your firm’s letterhead)
[Date]
Hanover
Model Conflict of Interest Waiver
[Client Name/Representative]
[Client Address]
RE: Disclosure and Conflict of Interest Waiver
Dear [Client Name]:
[Firm Name], in accordance with the American Institute of Certified Public Accountants’ (the “AICPA”)
Professional Standards and the Code of Professional Conduct, has determined that its acceptance of the
following engagements could constitute a conflict of interest under those Professional Standards.

We have been engaged to perform the following the following services:

For [Client Name], we have been engaged to [description of specific services to be provided].

For [Client Name], we have been engaged to [description of specific services to be provided].
Because of your [state reason for perceived conflict of interest (i.e. separation and divorce)], you may have
conflicting interests. Under the AIPCA Professional Standards and the Code of Professional Conduct, a conflict
of interest exists for our firm if an actual conflict exists, or if you or others might perceive that this firm or the
individual CPAs performing the above engagements are not performing the services in an impartial,
intellectually honesty and objective manner. Nonetheless, [Firm Name] has determined that they can both
perform the services and fulfill the duties owed to both of you in an objective, impartial and intellectually honest
manner.
However, before the CPAs can accept the above Proposed Engagement, the AICPA Professional Standards
require that we obtain your written and informed consent. By giving your consent, you are agreeing to waive
any objection to any potential or actual conflict of interest arising from the CPAs’ acceptance or performance of
the above-described Proposed Engagement.
By providing this information, The Hanover Insurance Group and its affiliates are not providing legal or any
professional advice. Please consult with an attorney to assist you with preparing an engagement letter that
meets your specific needs.
If you consent, please sign below. If you have any questions, feel free to contact us and to consult with your
legal counsel.
Very truly yours,
[Firm Name]
I hereby consent to the performance by [Firm Name] of the services described above and waive any claim
against [Firm Name] based on conflict of interest.
[Client Name]
[Date]
I hereby consent to the performance by [Firm Name] of the services described above and waive any claim
against [Firm Name] based on conflict of interest.
[Client Name]
[Date]
The information provided in this document is intended for use as a guideline and is not intended as, nor does it constitute, legal or professional advice. Neither The
Hanover Insurance Company or its affiliates and subsidiaries (“The Hanover”) shall be liable in tort or in contract to anyone who has access to or uses this
information. The Hanover does not warrant that adherence to, or compliance with, any recommendations or guidelines discussed within this document will result in
a particular outcome. This material does not amend, or otherwise affect, the provisions or coverages of any Hanover insurance policy or is it a representation that
coverage does or does not exist for any particular claim or loss under any such policy.
© 2015 The Hanover Insurance Group, Inc.
119-0461 (2/15)