SubmissionKit - Repositori Universitas Andalas DECLARATION FORM

Manuscript ID (for office only):      

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)
Work Tel:      
Mobile:      

E-MAIL 2 (secondary):

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:
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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I DECLARE THAT THE WORK SUBMITTED FOR PUBLICATION INDICATED ABOVE IS ORIGINAL, PREVIOUSLY UNPUBLISHED,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 NOT UNDER CONSIDERATION FOR ANY PUBLICATION ELSEWHERE.
Signature:
Date (dd/mm/yyyy):      
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
information as TRUE and CORRECT (Your digital signature is as legally binding as a physical signature).