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To,
The Chairman, Ethics Committee,
U. N. Mehta Institute of Cardiology & Research Centre,
Civil Hospital, Asarwa,
Ahmedabad 380 016
Sub: Research proposal submission for ethical clearance
Respected Sir,
The project titled “THESIS TOPIC” is being submitted to you for kind
consideration regarding ethical clearance for proposed study.
The study is being conducted in the department of ----------.
Yours sincerely,
U. N. Mehta Institute of Cardiology and Research Centre
(Affiliated to B. J. Medical College, Ahmedabad)
B. J. Medical College & Civil Hospital Campus,
Asarwa, Ahmedabad- 380 016, Gujarat, India
Tel: 079-2268 4200, 2268 4220, Fax : 079-2268 2092
Website: www.unmicrc.org, Email :unmicrc@gmail.com
Format for Application for Ad-hoc Research Project Proposal
and
Guidelines for Operation of Intramural Projects

Section A
General
1. Title of the Research Project:
2. Name and Designation of
i) Principal Investigator & Email:
ii) Co-Investigator (s) & Email:
Duration of Research Project:
i) Period which may be needed for collecting the data:
ii) Period that may be required for analyzing the data:
1. Amount of grant-in-aid asked for (details are to be furnished in Section B)

This is an intramural project and therefore it will have to be funded by institutional
resources. The expenditure incurred will be calculated separately and will be presented
along with the progress reports from time to time.
1. Institution responsible for the research project:

U. N. Mehta Institute of Cardiology and Research Centre, Civil Hospital Campus,
Ahmedabad,Gujarat
2. Institutional ethical clearance and Project approval:

(Necessary documents indicating institutional ethical clearance must be enclosed for
research involving human subjects as also animal experiments).
Yes___________√_________ No ____________________
1. Is radio tagged material proposed to be used in the project either for clinical trials or
experimental purposes? If so, clearance from Nuclear Medicine Committee, Bhabha
Atomic Research Centre, Mumbai, indicating should be attached.
No
2. Projects involving recombinant DNA/Genetic engineering work should be examined and

certificate by the Institutional Biosafety Committee (IBSC) to be enclosed. Guidelines
for constitution of IBSC can be obtained from Secretary, Department of
Biotechnology, CGO Complex, Lodhi Road, New Delhi-110003.
No
9. Approval of the institutional ethics committee (IEC) should be enclosed. Guidelines

for IEC for animal experiments should follow CPCSEA requirements and for human
studies should follow ICMR guidelines.
Nil
10. The Institution where the study is being done should ensure that there is no financial
conflict of interest by the investigators.
Declaration and Attestation
i. I/We have read the terms and conditions for UNMICRC institutional ethics
committee (IEC) Research Guideline. All necessary Institutional facilities will be
provided if the research project is approved for financial assistance.
ii. I/We agree to submit within one month from the date of termination of the project
the final report and a list of articles, both expendable and non-expendable, left on
the closure of the project.
iii. I/We agree to submit audited statement of accounts duly audited by the auditors
as stipulated by the IEC.
iv. It is certified that the equipment(s) is/are not available in the Institute/Department
or these are available but cannot be spared for the project
v. It is further certified that the equipment(s) required for the project have not been
purchased from the funds provided by IEC for another project(s) in the Institute.
vi. I/We agree to submit (online) all the raw data (along with descriptions) generated
from the project to the Institute Data Repository within one month from the date
of completion /termination of the project.
vii. If any equipment already exists with the Department/Institute, the investigator
should justify purchase of another equipment.
Signature of the:
a) Principal Investigator:
b) Co-Investigator (s):
c) Head of the Department
Signature of the Head of the Institution with seal

Date:
Section - B
Details of the Research Project
1. Title of the project:
2. Objectives:
3. Summary of the proposed research:
4. Present Knowledge:
5. Bibliography:
6. Preliminary work already done by the Investigator on this problem, e.g. selection of
subjects, standardization of methods, with results, if any.
Not Applicable
7. Links with other ICMR / Other funding agency projects (ad-hoc, task force or
collaborative).
Nil
8. List of important publications of last 5 years of the all the investigators in the relevant
fields (enclose reprints, if available)
CV Attached
9. Detailed research plan

10. Facilities in terms of equipment, etc, available at the sponsoring institution for the
proposed investigation. All the facilities do exist at UNMICRC for the execution of the
proposed research project
11. Budget requirements (with detailed break-up and full justification):

This is an intramural project and therefore it will have to be funded by institutional
resources. The expenditure incurred will be calculated separately and will be presented
along with the progress reports from time to time.
Section - C
Biodata (C. V.) of the Investigators
Name:
Designation:
Date of joining:
Date of joining present post:
Discipline:
Address (office):
Address (Resi.):
Telephone (Off.):
Fax:
Email address:
Educational qualifications:
Research experience:
Workshop\conference\symposiums:
Publication:

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Sub: Research proposal submission for ethical clearance

The study is being conducted in the department of ----------.

Format for Application for Ad-hoc Research Project Proposal

Guidelines for Operation of Intramural Projects

1. Title of the Research Project:

2. Name and Designation of

i) Principal Investigator & Email:

ii) Co-Investigator (s) & Email:

Duration of Research Project:

i) Period which may be needed for collecting the data:

ii) Period that may be required for analyzing the data:

1. Amount of grant-in-aid asked for (details are to be furnished in Section B)

1. Institution responsible for the research project:

2. Institutional ethical clearance and Project approval:

2. Projects involving recombinant DNA/Genetic engineering work should be examined and

9. Approval of the institutional ethics committee (IEC) should be enclosed. Guidelines

Declaration and Attestation

c) Head of the Department

Signature of the Head of the Institution with seal

1. Title of the project:

3. Summary of the proposed research:

9. Detailed research plan

11. Budget requirements (with detailed break-up and full justification):

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