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Conflict of Interest and Business Conduct Questionnaire

Name:
 Position:

Division:

Conflict of Interest

Yes No Do you or, to your knowledge, do any members of your or your spouse's family have any direct or indirect financial interest in or relationship with any organization doing business with AMETEK?
Yes No Have you or, to your knowledge, have any members of your or your spouse's family received, directly or indirectly, or are you or, to your knowledge, any members of your or your spouse's family, now receiving directly or indirectly, commissions, gifts, rewards, bonuses, compensation or gratuities from any organization outside of AMETEK doing business with AMETEK?
Yes No Have you or, to your knowledge, have any members of your or your spouse's family been engaged, directly or indirectly, or are you or, to your knowledge, any members of your or your spouse's family, now engaged, directly or indirectly, in any activity with, or in rendering services to, any organization which competes with the business conducted by AMETEK?
If the answer is YES to any of the above questions please specify a detailed statement naming the organization, disclosing the nature and extent of the financial interest or relationship and describing all business transactions involved and covering the nature and extent of the service or activity?

Business Conduct
Yes No Are you aware of AMETEK's Policy Guidelines for Business Conduct and have you conformed with these guidelines, especially with respect to:
Policy Guidelines for Business Conduct (PP #100.00.01)
Foreign Corrupt Practices Act of 1977 (PP #100.00.02)
Inside Information Policy: Guidelines and Procedures (PP #100.00.03)
Illegal Payments (PP #100.01.05)
International Boycotts (PP #100.01.08)
Conflict of Interest and Business Conduct (PP #100.20.02)
Purchasing Policies and Procedures (PP #400.30.01)
Code of Ethics and Business Conduct (PP #100.00.07)

Please note new policy added, PP100.00.07, Code of Ethics and Business
Conduct, which specifically includes procedures for reporting violations of company policy, including the confidential whistle blower hotline. This policy was added in February 2004.
Yes No N/A Have you made those you supervise aware of these Policy Guidelines?
Yes No Are you aware of any deviations from these Policy Guidelines anywhere in the AMETEK organization?
If the answer is YES, please provide a detailed statement describing such deviations?
Yes No Do you understand it is your responsibility to promptly prepare and submit a new form, if the responses to this data subsequently change?
By submitting this form, you agree you have read the Notice to all AMETEK Personnel which sets forth the obligation of Company personnel to maintain the confidentiality of important or sensitive information and refrain from trading securities on the basis of material, non-public information or from "tipping" others concerning such information. To the best of my knowledge, for the past calendar year, I have adhered to the policies set forth in the memorandum and have not knowingly violated my responsibilities as set forth therein.