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Lokmanya Tilak Municipal Medical College

and Lokmanya Tilak Municipal General Hospital

Sion Mumbai

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Home / Ethics Committee / Title Page Format

Title Page Format

 IEC No.# 
Project Type *Specify  as per Research Project  Processing Fee  Type
Abbreviated  Project Title (maximum  25 characters) 
Project Title ( Full ) 
Principal Investigator  Name 
Co – Investigator Name / Names 
Sponsor Name  * 
Checked and Complete #Sign by SRS Office Staff checking the documentDate
Project  Submission  Reviewer #Secretary IEC HR to assign Reviewers for Project
     
Sign Date of Secretary IEC HR
Project Reviewers Acknowledgement #Signature of ReviewersDate of Receipt
Clearance Letter  #MOM reference    Dispatch No.Receivers Signature
Project Closure Date #  

Note
a.    All Headings marked  “ # ” are for Office use

b.    Project Type  to be assigned as – Sponsored/ ICMR / SRS Sponsored / Thesis *

c.    Sponsor Name ( if applicable ) * else not to be typed

* Please select and type the appropriate choice

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