Application of Vote Virement Form

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SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM APPLICATION OF VOTE VIREMENT FORM

This form must be submitted to the Clinical Research Centre, Level 4, Sultan Ahmad Shah Medical Centre @IIUM, Kuantan, Pahang

INSTRUCTION:

1. ONLY PRINCIPAL INVESTIGATOR (PI) is eligible to fill up the Vote Virement Form.

2. Application of Vote Virement is ONLY allowed ONCE during the grant period.

3. ONLY Vote Virement with strong and valid JUSTIFICATION will be APPROVED.

FOR OFFICE USE

Document Complete / Incomplete

Date: ……….

Received by:

Name: ………..

Position: ………

Sultan Ahmad Shah Medical Centre @IIUM, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang Darul Makmur.

Tel: 09-591 2500

SASMEC- DEAR-CRC(SG)-F017 VER: 01 REV: 01 EFFECTIVE DATE: 03 OCTOBER 2022

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SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM APPLICATION OF VOTE VIREMENT FORM

A. RESEARCH GRANT INFORMATION

Principal Investigator

NRIC/Passport No Staff No

Office No Mobile No

Email Address K/C/D/I

Project ID Project Title

B. VIREMENT DETAILS CURRENT

VOTE

AMOUNT (RM)

TRANSFER VOTE

AMOUNT

(RM) JUSTIFICATION

C. DECLARATION BY APPLICANT

Tel: 09-591 2500

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SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM APPLICATION OF VOTE VIREMENT FORM

I, the requestor of the above, hereby declare that all the information given are TRUE and I have duly completed this form and attached all required supporting documents as in the checklist.

Signature : ____________________________ Date : _______________________

Stamp :

D. RECOMMENDATION OF THE DEPARTMENT

(Head of Department/ Head of Research / Deputy Dean Postgraduate and Research/ Dean)

Recommended Not Recommended

Remark (if any): _______________________________________________________________

Signature : ____________________________ Date : _______________________

Stamp :

E. DEPARTMENT OF EDUCATION AND RESEARCH Verified by:

Signature and Stamp:

Date:

Recommended by:

Recommended :

Not Recommended :

Remarks :

Signature and Stamp:

Date:

F. APPROVAL BY HOSPITAL DIRECTOR

Tel: 09-591 2500

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SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM APPLICATION OF VOTE VIREMENT FORM

Approved Not Approved

Remark (if any): _______________________________________________________________

Signature : ____________________________ Date : _______________________

Stamp :

Tel: 09-591 2500