Informed Consent Form

I am submitting the following article titled: “_________________________________________________________________________________________” for consideration for publication in the International Journal of Pathology. I hereby testify that this article is comprised of an
original and authentic research carried out by myself along with my co-authors. I affirm that this article is neither published before nor it is submitted for publication at present to any other journal.

I also assure that accepted norms of medical ethics have been observed in carrying out and presenting research findings. There is no conflict of interest in publishing this article. I declare that the research is not funded by any agency,
drug or reagent company etc. OR

I declare that the research is funded by:

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(Strike out which is not applicable)

Signature of the Principal Author

Name of the Principal author

Affiliation: