MULTIDIMENSIONAL PUBLICATIONS
Authorship Responsibility, Financial Disclosure, and Acknowledgment form.
By completing and signing this form, the corresponding author acknowledges and accepts full responsibility on behalf of all contributing authors, if any, regarding the statements on Authorship Responsibility, Financial Disclosure and Funding Support. Any box or line left empty will result in an incomplete submission and the manuscript will be returned to the author immediately.
Title
First Name
Middle Name
Last Name
Degree (Ph.D., M.D., Jr., etc.)
Contact No. (including country code)
Fax Number (including country code)
E-mail Address
Authorship Responsibility
By signing this form and clicking the appropriate boxes, the corresponding author certifies that each author has met all criteria below (A, B, C, and D) and hereunder indicates each author’s general and specific contributions by listing his or her name next to the relevant section.
• the manuscript represents original and valid work and that neither this manuscript nor one with substantially similar content under my authorship has been published or is being considered for publication elsewhere, except as described in an attachment, and copies of closely related manuscripts are provided; and
• if requested, this corresponding author will provide the data or will cooperate fully in obtaining and providing the data on which the manuscript is based for examination by the editors or their assignees;
• every author has agreed to allow the corresponding author to serve as the primary correspondent with the editorial office, to review the edited typescript and proof.
C. Each author has participated sufficiently in the work to take public responsibility for all of the content.
D. Each author qualifies for authorship by listing his or her name on the appropriate line of the categories of contributions listed below.
The authors listed below have made substantial contributions to the intellectual content of the wtiting in the various sections described below.
(list appropriate author next to each section – each author must be listed in at least 1 field. More than 1 author can be listed in each field.)
Ø cquisition of data
Ø analysis and interpretation of data
Ø drafting of the manuscript
Ø critical revision of the manuscript for
important intellectual content
Ø statistical analysis
Ø obtaining funding
Ø administrative, technical, or
material support
Ø supervision
Ø other (specify)
Financial Disclosure
None of the contributing authors have any conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript.
OR
I certify that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/ affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: (please list all conflict of interest with the relevant author’s name):
Funding Support and Role of the Sponsor
I certify that all funding, other financial support, and material support for this research and/or work are clearly identified in the manuscript.
The name of the organization or organizations which had a role in sponsoring the data and material in the study are also listed below:
All funding or other financial support, and material support for this research and/or work, if any, are clearly identified hereunder:
The acknowledgment section includes contributors who provided purely technical help, writing assistance, or a department chair who provided only general support. Financial and material support should also be acknowledged.
The specific role of the funding organization or sponsor is as follows:
Design and conduct of the study
Collection of the data
Management of the data
Analysis
Interpretation of the data
Preparation
Review
Approval of the manuscript
OR
No funding or other financial support was received.
Author Agreement Form Of Multidimensional
Publications
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Title of manuscript:
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First Author*:
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Corresponding author*:
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Full names of all authors (one per line):
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* at least name and e-mail address will be listed
We, the above mentioned authors declare that this manuscript contain original, unpublished results which are not currently being considered for publication elsewhere while for all reused data the agreement of the publisher is attached.
We confirm that the manuscript has been read and approved by all the authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us.
We understand that the corresponding author is the sole contact for the Editorial process. The corresponding author is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs.
Data:………………………….. ………………………………………..
Signed by corresponding author
on behalf of all authors
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