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    Conflict of Interest - BJP

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    Fathmawati Amir
    This document provides a conflict of interest disclosure form for authors submitting a paper. The six-part form requests information about: [1] the author's identity; [2] sources of funding for the work; [3] the author's other financial interests; [4] any intellectual property related to the work; [5] other relationships that could be perceived as influencing the work; and [6] a disclosure statement. Completing the form ensures readers are informed of any interests that could influence how they understand the author's work.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Conflict of Interest - BJP

    Uploaded by

    Fathmawati Amir
    30 views2 pages
    This document provides a conflict of interest disclosure form for authors submitting a paper. The six-part form requests information about: [1] the author's identity; [2] sources of funding for the work; [3] the author's other financial interests; [4] any intellectual property related to the work; [5] other relationships that could be perceived as influencing the work; and [6] a disclosure statement. Completing the form ensures readers are informed of any interests that could influence how they understand the author's work.

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    CoI of BJP

    Original Title

    Conflict of Interest_BJP

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    This document provides a conflict of interest disclosure form for authors submitting a paper. The six-part form requests information about: [1] the author's identity; [2] sources of funding for the work; [3] the author's other financial interests; [4] any intellectual property related to the work; [5] other relationships that could be perceived as influencing the work; and [6] a disclosure statement. Completing the form ensures readers are informed of any interests that could influence how they understand the author's work.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    30 views2 pages

    Conflict of Interest - BJP

    Uploaded by

    Fathmawati Amir
    This document provides a conflict of interest disclosure form for authors submitting a paper. The six-part form requests information about: [1] the author's identity; [2] sources of funding for the work; [3] the author's other financial interests; [4] any intellectual property related to the work; [5] other relationships that could be perceived as influencing the work; and [6] a disclosure statement. Completing the form ensures readers are informed of any interests that could influence how they understand the author's work.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    Conflict of Interest

    The purpose of this form is to provide readers of your paper with information about your other
    interests that could influence how they receive and understand your work. Each author should
    submit a separate form and is responsible for the accuracy and completeness of the
    submitted information. The form has six parts. Don't scan this copy
    Section 1: Identifying Information
    1. Your First Name: Middle Name: Family Name:

    2. Are the Corresponding Author


    Yes No If No, then name the Corresponding Author

    3. Manuscript Title:

    4. Manuscript ID:

    Section 2: The work under consideration for publication


    Your institution at any time receive payment or services from a third party (government,
    commercial, private foundation, etc.) for any aspect of the submitted work (including but not
    limited to grants, data monitoring board, study design, manuscript preparation, statistical
    analysis, etc.)?
    Are there any relevant conflicts of interest? Yes No
    If yes, please fill out the appropriate information below.
    Name of Institution/Company Grant? Personal Non-financial Others Comment
    fees support

    Section 3: Relevant financial activities outside the submitted work


    Place a check in the appropriate boxes in the table to indicate whether you have financial
    relationships (regardless of amount of compensation) with entities as described in the
    instructions. You should report relationships that were present during the 36 months prior to
    publication.
    Are there any relevant conflicts of interest? Yes No
    If yes, please fill out the appropriate information below.
    Name of Institution/Company Grant? Personal Non-financial Others Comment
    fees support

    Section 4: Intellectual Property - Patents & Copyrights


    Do you have any patents, whether planned, pending or issued, broadly relevant to the work?
    Yes No
    If yes, please fill out the appropriate information below.
    Patent? Pending? Issued? Licensed? Royalties? Licensee? Comment

    Section 5: Relationships not covered above


    Are there other relationships or activities that readers could perceive to have influenced, or that
    give the appearance of potentially influencing, what you wrote in the submitted work?
    Yes, the following relationships/conditions/circumstances are present (explain below):

    No other relationships/conditions/circumstances that present a potential conflict of interest

    Section 6: Disclosure Statement

    ORCID iD: Date:

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