Conflict of Interest Disclosure Form
Academic Researchers
Full Name
Affiliation / Department
Email
Research Project / Title
1. Financial Interests
List any financial interests (e.g., honoraria, stock ownership, consulting fees, grants) relevant to this research.
2. Personal Relationships
Disclose any personal or family relationships with entities or individuals that could influence the research.
3. Other Potential Conflicts
Disclose any other affiliations, commitments, or circumstances that might present a conflict of interest.
4. Declaration
I declare that the information provided above is complete and accurate to the best of my knowledge.
Signature
Date