| Title of Project | |
| Relationship | □ I (research director) □ immediate family □ co-author □ person in charge □ Other Study Related People( ) |
| □ Check the box | ||
| □ | I received 10 million won worth of expenses in the form of research funds, educational subsidies, research equipment, advice, or an honorarium for unlimited use from the supporting institution. Total Amount : |
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| □ | I have been provided with rights to economic benefits, such as equity profits or stock options of the supporting organization. Total Amount :Type : |
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| □ | I was provided with other equity profits or interests worth 10 million won or more than 5 percent. Total Amount : Type : |
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| □ | I have an official/informal title to the supporting body. (e.g., presidents, advisors, advisers, etc.) Affiliation : Position : |
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| □ | I have intellectual property rights to research subjects. (e.g., patents, gift certificates, licensing, royalties, etc.) Type : |
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| □ | The company to which my or my spouse's immediate family belongs has the same relationship as that described above. Kinship : |
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The research manager reports conflicts of interests as above.
Submission Date:
Submitted by: (Sign)
