Completion Report Form

SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM DEPARTMENT OF EDUCATION AND RESEARCH

COMPLETION REPORT FORM

A. RESEARCHER INFORMATION Name:

Department & Institution:

Research Title:

Completion date:

B. PROJECT OUTPUT Research output

*Please attach the related

document Thesis Abstract Journal Others

*If you wish to publish your research output, please fill up publication consent form. Any publication must obtain the consent from Hospital Director, SASMEC @IIUM

C. RESEARCHER DECLARATION

I, as named above, hereby confirm that I have completed my research project at SASMEC @IIUM. The information submitted in the above completion report is true and accurate at the date of submission of the report.

Submitted by:

………..

Name : ……….

Designation: ……….

Date : ……….

Acknowledged by:

(HEAD OF DEPARTMENT OF RESEARCH SITE)

………

Name : ………..

Designation: ………

Date : ………

FOR OFFICE USE ONLY Verification of research output

Thesis Abstract Journal Others

Reviewed by:

………..

Name : ……….

Designation: ……….

Date : ……….

Approved by:

………..

Name : ……….

Designation :Head Department of Education and Research Date : ………

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(GR)-F006 VER: 01 REV: 04 EFFECTIVE DATE: 20 SEPTEMBER 2022IIUM-IIUMMC-F000

VER: 01 REV: 00