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JPTM : Journal of Pathology and Translational Medicine


Conflict of interest form

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Conflict of Interest Disclosure Statement by an Author of a Manuscript submitted to Journal of Pathology and Translational Medicine

I, (We)                   , have submitted for publication in Journal of Pathology and Translational Medicine

a manuscript entitled:


I, (We) hereby certify, that to the best of our knowledge (Please circle one) :

1. No financial support of benefits have been received by me or any co-author, by any member of my (our) immediate family or any individual or entity with whom or with which I (we) have a significant relationship from any commercial source that is related directly or indirectly to the scientific work reported in the article except as described below.

2. I (we) understand an example of such financial interest would comprise a stock interest in any business entity, which is included in the subject matter of the manuscript or which sells a product relating to the subject matter of the manuscript:



If any commercial support or special financial interests are described above, I (we) understand that the Journal staff will make every effort to keep such information confidential during the editorial review process. I (we) also understand that if the manuscript is accepted, you will discuss with me (us) the manner to which such information, is to be communicated to the reader. I (we) hereby grant permission for any such information, or an appropriate summary to be published in the Journal with the manuscript if the manuscript is accepted for publication.

The corresponding authour has an obligation to making sure any and all co-authors sign and date in this form.

Name of the Corresponding Author:


Signature:                                              Date:                           

JPTM : Journal of Pathology and Translational Medicine