SubmissionKit - Repositori Universitas Andalas DECLARATION FORM

Manuscript ID (

for office on

ly):      

DECLARATION FORM

(Submission of Manuscript)

TYPE OF PAPER: (please X) Regular Paper Review

TITLE OF PAPER

:

     

PERSONAL DETAILS [IN CAPITALS PLEASE]

NAME OF THE CORRESPONDING AUTHOR IN FULL SEX : Male / Female

     

     

PREFERRED NAME (as in publication) NATIONALITY

     

     

FULL ADDRESS OF THE CORRESPONDING AUTHOR ORGANISATION NAME

                 

     

PERMANENT ADDRESS (if different from above) E-MAIL 1 (primary):      

           

CONTACT (please provide both landline and hand phone numbers with

country/area IDD codes) E-MAIL 2 (secondary):

Work Tel:       Mobile:            

SPECIALISATION(e.g. agriculture) OCCUPATION (e.g. R&D, student) JOB TITLE (e.g. professor, etc)      

                 

NAME(S) OF THE CO-AUTHOR(S) IN

FULL PREFERRED NAME(S) (as in publication) E-MAIL OF THE CO-AUTHOR(S)

                 

                 

                 

                 

                 

AUTHORSHIP SEQUENCE PROVIDE NAMES OF ALL AUTHORS IN THE PREFERRED SEQUENCE (Names as in publication, eg. Handoko, Gusdi Sastra, Ike Revita)

     

IMPORTANT NOTE:

 Manuscript that have been published in any form of publication is not allowed to be published in Arbitrer

 If previously published figures, tables, or parts of text are to be included, the copyright-holder’s permission must be obtained prior to submission.

 Submission also implies that all authors have approved the paper for release and are in agreement with its content.

DECLARATION:

I DECLARE THAT THE WORK SUBMITTED FOR PUBLICATION INDICATED ABOVE IS ORIGINAL, PREVIOUSLY UNPUBLISHED, AND NOTUNDER CONSIDERATION FOR ANY PUBLICATION ELSEWHERE.

Signature:

Name of Correspoinding author:

     

* By

typing your name into the above space, it implies that you have signed this form, understood the declaration and accepted all the