フィリッピン標準研究契約申請

APPLICATION FOR RESEARCH AGREEMENT

______ ARA _______CRA

1.a
Name ____________________________________________________
Last Name First Name Middle Name
Nationality ______________ Degree (Sought/Completed) ________________
Nature of Employment: Government __________________________________
Private __________________________________
Present Position/Official Designation __________________________________
School/Institution/Agency ___________________________________________

1.b
Company/Organization/Institution/Agency
(To be filled up by Head)
Name of Company/Institution/Organization/Agency:
____________________________________________________________
Address ____________________________________________________
Head _______________________________________________________
Tel. No. ________________________ Fax No. ____________________

2. Species/Specimen kind and number/quantity to be collected (e.g. mammals, birds, flowering plants, signs, etc.)
____________________________________________________________
____________________________________________________________

3. Purpose of Collection ________________________________________
____________________________________________________________
____________________________________________________________

4. Places of Collection __________________________________________
____________________________________________________________
____________________________________________________________

5. List of researches (foreign and local counterpart) indicate role in project implementation (attach resume)
____________________________________________________________
____________________________________________________________
____________________________________________________________

6. List of Foreign researchers/contact person assisting you in the field and institutional affiliations
___________________________________________________________
___________________________________________________________

7. List of cooperating Filipino researchers and their institutional affiliations
___________________________________________________________
___________________________________________________________

I certify that the statements made herein are correct and true and I will abide by the decision of the IACBGR on this application.
___________________
Signature
___________________
Date

SUBSCRIBED AND SWORN BEFORE ME this _____ day, 199__ at _________________________, Philippines, personally appeared with Residence Certificate No. __________________ issued on _________, 199__ at ________________ known to me to be the same person who executed the foregoing instrument and acknowledge to me that the same is his/her voluntary act and deed.

Notary Public
—————————————————————————————–
Please submit the following documents together with this duly signedapplication form:
____1. Three (3) copies of research proposal following attached format.
____2. For 1.a applicants, Letter of endorsement from Head of Institution where applicant is affiliated or Reputable Institution, Museum or University as may be required.
____3. For 1.b applicants, Company/Institution/Organization/Agency Profile
____4. Letter of acceptance from Filipino counterpart(s) authorized by or representing the host institutions to cooperate in your activities in the Philippines.
____5. Two (2) 2″ x 2″ ID Picture
____6. Others

フィリッピン標準研究提案

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