Ethical Clearance Form

REGENT BUSINESS SCHOOL
ETHICAL CLEARANCE FORM
Section 1 : Personal Details
1.1 Full Name and Surname Obert Mwangelwa Sanyambe
1.2 Student Number MBA107140
1.3 Contact Details:
Telephone Number 065231339 (h)
Cell Number 0812086922
Email: omsanyambe@iway.na
osanyambe@unam.na
Supervisors Details:
Name:
Telephone Number
Email
Section 2: Dissertation Description
2.1 Dissertation title
Investigating the Impact of Service Delivery on Customer Satisfaction

2.2 Proposed work plan
Steps Dates
Chapter One
Chapter Two
Chapter Three
Chapter Four
Chapter Five
Section 3 : Ethical Issues
The RBS Research Ethics Policy applies to all members of staff and post graduate student who
are involved in research on or off the RBS campus. In addition any person not affiliated with
RBS who wishes to conduct research with RBS students and/ or staff is bound by the same ethics
framework.
All students and staff members are to familiarise themselves with and sign an undertaking to
comply with RBSs Code of Conduct for Research
Question 3.1
Will data collection involve any of the following Yes No
Access to confidential information without prior consent of participants x

Participants being required to commit an act which might diminish self respect or
cause them to experience shame, embarrassment or regret
x
Participants being exposed to questions which may be experienced as stressful or

upsetting, or to procedures which may have unpleasant or harmful side effects
x
The use of stimuli, tasks or procedures which may be experienced as stressful,

noxious or unpleasant
x
Any form of deception x

If YES explain and justify. Explain what steps you will take to minimise the potential
stress/ harm.
Question 3.2
Will any of the following instruments be used for purposes of data collection YES No
Questionnaire x
Survey schedule x
Interview schedule x
Assessment instruments x
If YES attach a copy of the research instrument
Question 3.3
Will the autonomy of participants be protected through the use of and informed YES NO
consent form, which specifies [in language respondents will understand]
The nature and purpose/ s of the research x

The identity and institutional association of the researcher and supervisor/ project
leader and their contact details
x
The fact that participation is voluntary x

The responses will be treated in a confidential manner x
Any limits on confidentiality which may apply x
The anonymity will be ensured where appropriate [e.g. coded/ disguised names of
participants/ respondents/ institutions]
x
The fact that participants are free to withdraw from the research at any time
without any negative or undesired consequences to themselves
x
If NO, this needs to be explained and justified. The measures to be adopted to ensure that the
respondents fully understand the nature of the research and the consent that they are giving.
Question 3.4
Storage and Disposal of Research Data
Data collected must be scanned and copied onto a CD and sent to RBS for storage. This data
will be kept by RBS for a period of at least FIVE years.
How will the research data be disposed of? Please provide specific information e.g. shredding
of documents, incineration of videos, cassettes etc.
Data will be disposed off by shredding
Question 3.5
In the subsequent dissemination of your research findings in the form of a finished

dissertation, publication etc how will the anonymity/ confidentiality be protected?
Participants will be informed of the importance and purpose for the study. The survey
questionnaire for the study will not include sensitive questions that could cause humiliation
or uncomfortable feelings. Participant identity will be kept confidential. Subsequently the
survey will also be confidential in regards to responses and the reporting of findings. The
researcher is also obliged to inform the respondents how the results are intended to be used,
and who will have access to the data. Thus, the results of the study would be used in a
dissertation as partial fulfilment for a Master degree.
Question 3.6
Has any organisation/ company participating in the research or funding the project , imposed
any conditions to the research : YES/NO
If YES, indicate what the conditions are:
.
SECTION 4 : FORMALISATION OF THE APPLICANT
APPLICANT
I have familiarised myself with RBSs Code of Conduct for Research and undertake to
comply with it. The information supplied above is correct to the best of my knowledge.
Signature of Applicant: Date:
[Ensure that the check list on this form is complete]
SUPERVISOR
Ensure that the applicant has completed the attached check list and that the form is forwarded
to the RBSs Research Dept
Signature of Supervisor: Date:
RECOMMENDATION OF THE RESEARCH DEPT
The Applicant is:
Approved
Recommended and referred to the Ethics Committee for further consideration
Not Approved, referred back for revision and resubmission
Name of Head: Signature
Date:
REGENT BUSINESS SCHOOL
RESEARCH DEPARTMENT
ETHICAL CLEARANCE APPLICATION FORM
Checklist for Application
[Please tick]
1. The form has been fully completed and all questions have been answered

2. Questionnaire attached [where applicable]

3. Informed consent document attached

4. Approval from relevant authorities obtained [and attached ] where research
involves data/ facilities or other institutions/ organisations
5. Signature of Supervisor
6. Application forwarded to the Research Dept for recommendation

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What steps are involved in the proposed work plan?

What steps are involved in the proposed work plan?

What ethical issues need to be addressed in the research?

What ethical issues need to be addressed in the research?

REGENT BUSINESS SCHOOL

ETHICAL CLEARANCE FORM

Section 1 : Personal Details

1.1 Full Name and Surname Obert Mwangelwa Sanyambe

1.2 Student Number MBA107140

1.3 Contact Details:

Telephone Number 065231339 (h)

Cell Number 0812086922

Section 2: Dissertation Description

2.1 Dissertation title

Investigating the Impact of Service Delivery on Customer Satisfaction

Section 3 : Ethical Issues

Will data collection involve any of the following Yes No

Access to confidential information without prior consent of participants x

Participants being exposed to questions which may be experienced as stressful or

The use of stimuli, tasks or procedures which may be experienced as stressful,

Any form of deception x

If YES attach a copy of the research instrument

The nature and purpose/ s of the research x

The fact that participation is voluntary x

Storage and Disposal of Research Data

Data will be disposed off by shredding

In the subsequent dissemination of your research findings in the form of a finished

If YES, indicate what the conditions are:

Signature of Applicant: Date:

[Ensure that the check list on this form is complete]

Signature of Supervisor: Date:

RECOMMENDATION OF THE RESEARCH DEPT

The Applicant is:

Recommended and referred to the Ethics Committee for further consideration

Not Approved, referred back for revision and resubmission

Name of Head: Signature

ETHICAL CLEARANCE APPLICATION FORM

Checklist for Application

6. Application forwarded to the Research Dept for recommendation

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