SRG Project Completion Form

(1)

SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM PROJECT COMPLETION FORM

This form must be submitted to the Clinical Research Centre, Level 4, Sultan Ahmad Shah Medical Centre @IIUM, Kuantan, Pahang CHECKLIST FOR COMPLETION OF RESEARCH PROJECT - Please tick (√)

NO. ITEMS Check List

1. Completed of Final Grant Report Form 2. Evidence of Research Report

3. A copy of seminar paper, conference, proceedings, publications 4. Attach Original Receipts

(Kindly sort the receipts according to votes / budgets and properly pasted on separate sheets) NOTE

The research project is considered completed once all the above have been submitted and all disbursed funds have been fully reconciled

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)-F011 VER: 01 REV: 01 EFFECTIVE DATE: 03 OCTOBER 2022

(2)

SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM PROJECT COMPLETION FORM

A. PROJECT INFORMATION

Type of Grant SASMEC Research Grant (RM 20,000)

Awarded Date Completion

Date Project ID

Project Title

B. RESEARCHERS INFORMATION

Role Name K/C/D/I Email

Project Leader

Project Members

C. PROJECT ACHIEVEMENT

ACHIEVEMENT PERCENTAGE Project progress according to milestones

achieved up to this period 0 - 25% 26 - 50% 51 - 75% 76 - 100%

Percentage (Please state #%)

Research Output Number of Articles

(Please attach the First Page of Publication)

Indexed Journal / MyCite Non-Indexed Journal

Conference Proceeding (If any)

International National

D. EXPENDITURE INFORMATION

Description Amount (RM) Remarks

Budget Approved Amount Spent Balance

Percentage of Amount Spent

E. EXPENSES DETAIL - Please indicate the details of the expenditure

Items Amount (RM)

Subtotal (RM) Year 1 Year 2

Tel: 09-591 2500

(3)

SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM PROJECT COMPLETION FORM

Vote 11000 (Salary and wages for Research Assistant)

Vote 21000 (Travelling, Lodging and Transportation)

Vote 23000 (Communication and Utilities)

Vote 27000 (Research Materials & Supplies)

Vote 29000 (Professional services, hospitality & other services including printing)

Tel: 09-591 2500

(4)

SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM PROJECT COMPLETION FORM

SUBTOTAL TOTAL F. DECLARATION BY PROJECT LEADER

I hereby declare that:

All information stated here are TRUE.

Signature : ____________________________ Date : _______________________

Stamp :

G. DEPARTMENT OF EDUCATION AND RESEARCH Verified by:

Signature and Stamp:

Date:

Approved by:

Remarks :

Signature and Stamp:

Date:

Tel: 09-591 2500