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RMU FACULTY RESEARCH INFORMATIONPERFORMA

FOR PERIOD 2014-17 INSTRUCTIONS:

1. The Performa comprises of eight sections. Kindly complete all eight sections.

2. Provide informationon yearly basis, of all the research projects, publications, courses. Workshops, paper presentations, research awards, and research scholarships of staff members of your department specifically for the time period of 1st January 2014 till 31st

December 2017.

3. The account of all research related activities should be given in reverse chronological order, i.e. beginning with the latestin first table or row and concluding with the oldest in last table or row.

4. The publications of all the staff members of the Department should be cited collectively in tables of sectionC, under respective headings. In case any publication includes names of more than one staff member of the department as authors, it should not be repeated in the table and should be mentioned only once in the table.

5. The citation count should also be mentioned for each publication in section C.Citation count refers to the total number of times a researcher’s work has been cited by other research publications. (Please note it is NOT the count of how many times your publication has been

accessed or read).

EXAMPLE: How to find out the citation count of your publication:

To to find how many times your article has been cited, enter information about the article into the

search engine's search box, as shown below. It's generally sufficient to enter just the first few words of

an article's title -- which should be put between quotation marks so that the words will be searched for

as a phrase -- along with an author's last name. (In this case, the article of interest is Sara L. Rynes,

Barry Gerhart, and Kathleen A. Minette's 2004 article from Human Resource Management entitled

"The importance of pay in employee motivation: Discrepancies between what people say and what

they do.")

The number of citations for the article will be shown below the article's information on the search

results page. In this case, Google Scholar indicates that the article has been cited by 451 documents

that are indexed by Google Scholar:

In some cases, you can even find the citation count by the end of your research paper if you open the

whole document in a journal.

6. Category of the journal in which your research work was published means the following categories:Mechanism for Classification of HEC Recognized Journals All Science Journals to be Classified as W, X, Y, Z

CATEGORY W: Journals having an Impact Factor.

Experts groups certify that they are top, recognized journals in the subject of archival quality.

CATEGORY X: Journals not having an Impact Factor

Verified by HEC that they meet all HEC Journal Criteria and have paper reviewed by at least one expert from an

Industrially/Academically

advanced country in the respective discipline.

Experts groups certify that they are top, recognized journals in the subject of archival quality.

CATEGORY Y: Journals not having an Impact Factor

They meet all HEC Journal Criteria except review of each paper by at

least one expert from an Industrially/Academically advanced country in the respective discipline.

Experts groups certify that they are good, recognized journals in the subject of archival quality.

CATEGORY Z: Journals not having an Impact Factor They meet all HEC Journal Criteria except

i. Review of each paper by at least one expert from an Industrially/Academically advanced country in the respective discipline.

ii. Abstracted / Indexed Internationally by a recognized Agency.

The information of the category of National journals of health sciences is available in an updated list

at the website of Higher Education Commission (http://www.hec.gov.pk).

The International Science Journals having an impact factor and are listed in Journal Citation Report

(JCR: http://admin-apps.isiknowledge.com/JCR/JCR?SID=Q1IdkG4hadKgmAmbpEM) of ISI

(www.isiknowledge.com) are considered as HEC Recognized Journals in “W” category. Note: Australian Journal of Basic and Applied Sciences (ISSN: 1991-8178) is not a HEC recognized Journal and cannot be

considered for any academic benefit.

7. If more than one staff members of a Department have conducted/facilitated the same Research course/workshop, use one single table of section E for that specific course/workshop and specify the names and designations of all staff members of Department

in the rows of table allocated. Please avoid making separate tables for each staff member for same workshop. Please note that research workshop/course are only those related to any research or research methodology, hence avoid including clinical courses.

8. If more than one staff members of a Department have attended the same Research course/workshop, utilize one single table of section F for that specific course/workshop and specify the names and designations of all staff members of Department who attended that course in the rows of table allocated.Please avoid making separate tables for each staff member for same workshop.

9. If any faculty member of a department has left Rawalpindi Medical University but had conducted research and had publications during period 2014-17 should be contacted at convenience and his/her relevant information must be included for the specified period for that department. Whereasany faculty member who has been migrated or shifted from one unit to another unit of RMU must provide their relevant researchinformation of the specific time period spent in previous department to that previous department while the research information for time period spent in current department should be included in that departments performa accordingly.

10. The typing format should be same throughout the Performa, that is, font style should be Arial, regular, size 10, color black andline spacing 1.5.

11. Do not use Abbreviations. If inevitably used any in title, please mention full name in bracket too.

12. If any category does not conform to your situation or if there is nothing to mention, mention NA (Not Applicable) or NONE respectively in that box.

13. In tables where the information regarding amount of fund/grant received by department/individuals for research projects, scholarships, awards, paper presentation or for participation in course/workshop is required Pakistani Rupees, if record of exact amount not available then give an estimate of amount.

14. For publications, Vancouver referencing system should beaccurately followed as follows:

a. If it is a Book:1. Books: printAuthor/Editor (if it is an editor/editors always put (ed./eds.) after the name)Title (this should be in italics)Series title and number (if part of a series)Edition (if not the first edition)Place of publication (if there is more than one place listed, use the first named)Publisher

Year of publicationEXAMPLE:

Simons NE, Menzies B, Matthews M. A Short Course in Soil and Rock Slope Engineering. London: Thomas Telford

Publishing; 2001.

2. Books: electronicAuthor/Editor (if an editor/editors always put (ed./eds.) after the name)Title (this should be in italics)Series title and number (if part of a series)Edition (if not the first edition)Place of publication (if there is more than one place listed, use the first named)PublisherYear of publicationURLDate of accessEXAMPLE:

Simons NE, Menzies B, Matthews M. A Short Course in Soil and Rock Slope Engineering. London: Thomas Telford

Publishing; 2001. www.myilibrary.com?ID=93941 (accessed 18 Jun 2008).

3. Books: chapter in an edited bookAuthor of the chapterTitle of chapter followed by, In:Editor (always put (ed./eds) after the name)Title of book (this should be in italics)Series title and number (if part of a series)Edition (if not the first edition)Place of publication (if there is more than one place listed, use the first named)PublisherYear of publicationPage numbers (use 'p' before the page numbers. Elide the page numbers)EXAMPLE:

Moran MJ. Engineering thermodynamics. In: Kreith F, Goswami DY (eds.) The CRC handbook of mechanical

engineering. 2nd ed. Boca Raton, FL: CRC Press; 2005. p75 - 81.

b. If it is a Journal article:1.Journal articles: printAuthor Title of journal articleTitle of journal (this should be in italics)Year of publicationVolume number(Issue number)Page numbers of the articleEXAMPLE:

Chibber PK, Majumdar SK. Foreign ownership and profitability: Property rights, control, and the performance of firms in

Indian industry. Journal of Law & Economics 1999;42(1): 209-238.

2. Journal articles: electronicIf an electronic journal article has a DOl (digital object identifier), you can use this instead of the URL. The DOl is a

permanentidentifier provided by publishers so that the article can always be found online.

AuthorTitle of journal articleTitle of journal (this should be in italics)Year of publicationVolume number(Issue number)Page numbers of the articleURL or DOlDate of accessEXAMPLE:

Arrami M, Garner H. A tale of two citations. Nature 2008;451(7177): 397-9.

www.nature.com/nature/journal/v451/n7177/full/451397a.html (accessed 20 January 2008).

or

Wang F, Maidment G, Missenden J, Tozer R. The novel use of phase change materials in refrigeration plant. Part 1:

Experimental investigation. Applied Thermal Engineering. 2007;27(17-18): 2893-2901.

doi:10.1016/j.applthermaleng.2005.06.011. (accessed 14 July 2008).

c. If it is a Thesis:Theses (Final written work by PhD and postgraduate students, dissertations, project reports, discourses and essays by any

student.)

AuthorTitle (this should be in italics)Type of thesisAcademic institutionYear of publication

EXAMPLE:

Leckenby RJ. Dynamic characterisation and fluid flow modelling of fractured reservoirs. PhD thesis. Imperial

College London; 2005.

15. Email soft copy of the Performa,till 2 pm Saturday, 10 th March 2018, to email address mentioned below:.E-mail Address: ‘[email protected]’The subject of the mail should start with “Research faculty RMU 2018……. ” followed by the name of your Department, Unit& Hospital.

16. One printed version of the same electronic form should also be submitted to Dr AbidaShehzadi or Dr Rabbiyah (Demonstrators at DME, RMU) till 2 pmon Saturday, 10 th March 2018at the department of Medical Education, New teaching block, Rawalpindi medical University. Please note that the size of headings has been kept exceptionally large while text and tables also have many spaces in between in the electronic version, in order to make them conveniently visible to you. While taking a print please decrease the font size of whole document to 10 that will reduce the number of pages to be printed hence saving your printing expenses.

Section ADEPARTMENT

NAME OF DEPARTMENT:

UNIT:

NAME OF HOSPITAL(in case of basic

sciences the old campus or new teaching

block should be mentioned accordingly):

Section BRESEARCH PROJECTS CONDUCTED AT

THE DEPARTMENT I. PROJECTS CONDUCTED DURINGPERIOD

1ST JANUARY 2014 - 31ST DECEMBER 2014TOTAL NUMBER OF PROJECTS IN 2014: _______

DETAILS OF PROJECTS:

Research Project # 01-(2014)

Title of the Research Project

Date of Initiation of project

Current Status of Project(Ongoing/Completed)

If completed, Date of Completion:If ongoing, expected date of Completion:

Total Duration of project in months

Study Site & Setting

Name/ s of Principal Investigator/s with Designation.

Name/ s of Co-Investigator/s with Designation.

Funding Source of Research project

Amount of research fund/grant received by department/individuals for this project by funding agency in Pakistani Rupees

Name of Project Collaborative party, Department or Institute, if any.

Whether formal approval from Institutional Research Forum of RMU for this project was taken? (YES/NO)

Research Project # 02 -(2014)


























(Copy and Paste same table for more research projects and fill them accordingly and please don’t forget to put their respective headings and numbers as

mentioned above in chronological order. If not even a single research project was conducted during above mentioned period then please delete the empty tables and mention “NONE” under the heading)

II. PROJECTS CONDUCTED DURING PERIOD 1ST JANUARY 2015 - 31ST DECEMBER 2015TOTAL NUMBER OF PROJECTS IN 2015: _______













Research Project # 03-(2015):













(Copy and Paste same table for more research projects and fill them accordingly and please don’t forget to put their respective numbers and headings. If not even a single research project was conducted during above mentioned period, then please delete the empty tables and mention “NONE” under the heading)

III. PROJECTS CONDUCTED DURING PERIOD 1ST JANUARY 2016 - 31ST DECEMBER 2016TOTAL NUMBER OF PROJECTS IN 2016: _______














(Copy and Paste same table for more research projects and fill them accordingly and please don’t forget to put their respective numbers. If not even a single research project was conducted during above mentioned period, then please delete the empty

tables and mention “NONE” under the heading)

IV. PROJECTS CONDUCTED DURING PERIOD 1ST JANUARY 2017 - 31ST DECEMBER 2017TOTAL NUMBER OF PROJECTS IN 2017 : _______












(Copy and Paste same table for more research projects and fill them accordingly and please don’t forget to put their respective numbers. If not even a single research project was conducted during above mentioned period then please delete the empty tables and mention “NONE” under the heading)

Section C

RESEARCH PUBLICATIONSI. PUBLICATIONS DURING PERIOD

1ST JANUARY 2014- 31ST DECEMBER 2014TOTAL NUMBER OF PUBLICATIONS IN 2014: NUMBER OF BOOKS _______NUMBER OF CHAPTERS IN BOOKS _______NUMBER OF ORIGINAL ARTICLES _______NUMBER OF CASE REPORTS _______NUMBER OF SHORT COMMUNICATIONS _______NUMBER OF EDITORIALS _________NUMBER OF THESES ______

DETAILS OF PUBLICATIONS:

i. BOOK/S-(2014)

Serial#

PUBLICATIONS (IN VANCOUVER REFERENCING STYLE

Citation count

1.2.3.4.5.

ii. CHAPTER/S IN BOOKS-(2014)Serial

#PUBLICATIONS (IN VANCOUVER REFERENCING

STYLECitation count

1.2.3.4.5.

Several tools for citation analysis not only index journal articles but also books, book chapters and other non-traditional sources etcif electronically available. So please check their citation counts and mention but if it is not available mention “NOT AVAILBLE” in column of citation count.

iii. PUBLICATIONS IN INTERNATIONAL JOURNALS-(2014):

Serial#

PUBLICATION (IN VANCOUVER REFERENCING STYLE

Category of Journal

Citation count

1.2.3.4.5.6.7.8.9.10.

Please mention all international publications including original articles, case reports, short communications, and editorials. Also if more than 10 publications then please include more rows with respected serial numbers in chronological order and if no publication at all then write NONE under the heading and delete the empty table.

iv. PUBLICATIONS IN NATIONAL JOURNALS-(2014):

Serial PUBLICATION (IN VANCOUVER Category of Citation count

# REFERENCING STYLE Journal1.2.3.4.5.6.7.8.9.10.

Please mention all national publications including original articles, case reports, short communications, and editorials. Also if more than 10 publications then please include more rows with respected serial numbers in chronological order and if no publication at all then write NONE under the heading and delete the empty table

v. PUBLICATIONS OF THESES-(2014):Serial

#DETAILS OF THESIS (IN VANCOUVER REFERENCING

STYLETHESIS WAS

REQUISITE TO WHICH

DEGREE (eg MSc, Mphil, MD,

MS, PhD etc)1.2.3.4.5.6.7.8.9.10.

Also if more than 10 theses then please include more rows with respected serial numbers in chronological order and if no thesis published by faculty at all then write NONE under the heading and delete the empty table

II. PUBLICATIONS DURING PERIOD 1ST JANUARY 2015- 31ST DECEMBER 2015TOTAL NUMBER OF PUBLICATIONS IN 2015: NUMBER OF BOOKS _______NUMBER OF CHAPTERS IN BOOKS _______NUMBER OF ORIGINAL ARTICLES _______NUMBER OF CASE REPORTS _______NUMBER OF SHORT COMMUNICATIONS _______NUMBER OF EDITORIALS _________NUMBER OF THESES ______


i. BOOK/S-(2015)Serial


STYLECitation count

1.

2.3.4.5.



STYLECitation count

1.2.3.4.5.

Several tools for citation analysis not only index journal articles but also books, book chapters and other non-traditional sources etc if electronically available. So please check their citation counts and mention but if it is not available mention “NOT AVAILBLE” in column of citation count.


Serial#


Category of Journal

Citation count

1.2.3.4.5.6.7.8.9.10.



Serial#


Category of Journal

Citation count

1.

2.3.4.5.6.7.8.9.10.




STYLETHESIS WAS

REQUISITE TO WHICH


MS, PhD etc)1.2.3.4.5.6.7.8.9.10.


III. PUBLICATIONS DURING PERIOD 1ST JANUARY 2016- 31ST DECEMBER 2016TOTAL NUMBER OF PUBLICATIONS IN 2016: NUMBER OF BOOKS _______NUMBER OF CHAPTERS IN BOOKS _______NUMBER OF ORIGINAL ARTICLES _______NUMBER OF CASE REPORTS _______NUMBER OF SHORT COMMUNICATIONS _______NUMBER OF EDITORIALS _________NUMBER OF THESES ______




STYLECitation count

1.2.3.4.

5.



STYLECitation count

1.2.3.4.5.



Serial#


Category of Journal

Citation count

1.2.3.4.5.6.7.8.9.10.



Serial#


Category of Journal

Citation count

1.2.

3.4.5.6.7.8.9.10.




STYLETHESIS WAS

REQUISITE TO WHICH


MS, PhD etc)1.2.3.4.5.6.7.8.9.10.


IV. PUBLICATIONS DURING PERIOD 1ST JANUARY 2017- 31ST DECEMBER 2017TOTAL NUMBER OF PUBLICATIONS IN 2017: NUMBER OF BOOKS _______NUMBER OF CHAPTERS IN BOOKS _______NUMBER OF ORIGINAL ARTICLES _______NUMBER OF CASE REPORTS _______NUMBER OF SHORT COMMUNICATIONS _______NUMBER OF EDITORIALS _________NUMBER OF THESES ______




STYLECitation count

1.2.3.4.5.



STYLECitation count

1.2.3.4.5.



Serial#


Category of Journal

Citation count

1.2.3.4.5.6.7.8.9.10.



Serial#


Category of Journal

Citation count

1.2.3.4.

5.6.7.8.9.10.


v. PUBLICATIONS OF THESES-(2017):

Serial#

DETAILS OF THESIS (IN VANCOUVER REFERENCING STYLE

THESIS WAS REQUISITE TO

WHICH DEGREE (eg

MSc, Mphil, MD, MS, PhD etc)

1.2.3.4.5.6.7.8.9.10.

If more than 10 theses then please include more rows with respected serial numbers in chronological order and if no thesis published by faculty at all then write NONE under the heading and delete the empty table

Section D

RESEARCHPAPER PRESENTATIONS(ORAL/POWERPOINT

OR POSTER PRESENTATIONS)BY FACULTY MEMBERS OF DEPARTMENT

I. FORPERIOD 1ST JANUARY 2014 TILL 31ST

DECEMBER 2014Total number of research papers presented by faculty members Department in 2014 :_________a. Number of Oral/PowerPoint presentations:b. Number of poster presentations:

Details of presentations:

Research Paper Presentation # 01-(2014)Title of Research PaperName/Title of Conference

Dates of Conference

Venue of Conference with the name of the city and country.

Mention type of presentation (Oral/PowerPoint/poster):Name/s and Designation/s of staff member/s of Department who delivered the presentation

Name/s and Designation/s of staff member/s (co-investigators or co-authors) of Department whose research work was presented

Any fund/grant received by department/individuals for this paper presentation by any funding agency or organizing committee? (eg travel grants, logistic grants, payment of presentation or registration fee, accommodation fee etc)YES /NO

If yes please mention the source of funding (name of funding organization or institution)

If yes please mention the amount of fund/grant received by department/individuals collectively for this presentation in Pakistani Rupees.

Research Paper Presentation # 02-(2014)

Title of Research PaperName/Title of Conference

Dates of Conference

Venue of Conference with the name of the city and country.Mention type of presentation (Oral/PowerPoint/poster):Name/s and Designation/s of staff member/s of Department who delivered the presentation





Research Paper Presentation # 03 -(2014)


Dates of Conference






(Copy and Paste same table for more research paper presentations if more than 3 and please don’t forget to put their respective numbers as research paper presentation ### on top of table)

II. FOR PERIOD 1ST JANUARY 2015 TILL 31ST

DECEMBER 2015Total number of research papers presented by faculty members Department in 2015:_________

a. Number of Oral/PowerPoint presentations:b. Number of poster presentations:




Dates of Conference








Dates of Conference








Dates of Conference






(Copy and Paste same table for more research paper presentations if more than 3 and please don’t forget to put their respective numbers as research paper

presentation ### on top of table)

c. FOR PERIOD 1ST JANUARY 2016 TILL 31ST

DECEMBER 2016Total number of research papers presented by faculty members Department in 2016:_________





Dates of Conference








Dates of Conference








Dates of Conference






(Copy and Paste same table for more research paper presentations if more than 3 and please don’t forget to put their respective numbers as research paper presentation ### on top of table)

c. DURING PERIOD 1ST JANUARY 2017 TILL 31ST DECEMBER 2017

Total number of research papers presented by faculty members Department in 2017:_________





Dates of Conference








Dates of Conference








Dates of Conference






(Copy and Paste same table for more research paper presentations if more than 3 and please don’t forget to put their respective numbers as research paper

presentation ### on top of table)

Section E

RESEARCH COURSES/ WORKSHOPS ORGANIZED/ FACILITATED OR

CONDUCTED BY FACULTY MEMBERS OF DEPARTMENT

I. DURING PERIOD 1ST JANUARY 2014 TILL 31ST

DECEMBER 2014Total number of research workshops/courses organized/facilitated or

conducted by department during 2014:___________

Details of courses or workshops:

Research Course/Workshop# 01-(2014)Title of Research Course/ Workshop.

Dates of Course/ Workshop

Total Duration of Conference/workshop

Venue of Course/Workshop with the name of the city and country.

Name and Designation of staff member of Department who facilitated/ conducted the course/workshopTotal number of participants of workshop/course

Research Course/Workshop # 02-(2014)Title of Research Course/ Workshop.










(If more than 3 research courses/workshops, then copy and Paste same table for more research courses/ workshops conducted or facilitated by your department and please don’t forget to put their respective numbers in headings.)

II. DURING PERIOD 1ST JANUARY 2015 TILL 31ST









Research Course/Workshop # 02-(2015)

Title of Research Course/ Workshop.











III. DURING PERIOD 1ST JANUARY 2016 TILL 31ST










IV. DURING PERIOD 1ST JANUARY 2017 TILL 31ST











Section F

RESEARCH COURSES/ WORKSHOPS ATTENDED BY STAFF MEMBERS OF

DEPARTMENT

I. FOR PERIOD 1ST JANUARY 2014 TILL 31ST

DECEMBER 2014Total number of research workshops/courses attended by faculty members of

department during 2014:___________






Name/s and Designation of staff member/s of Department who attended the course/workshop

Any fund/grant received by department/individuals for participation in this course/workshop by any funding agency or organizing committee? (eg travel grants, logistic grants, payment of participation or registration fee, accommodation fee etc)YES /NO










(Copy and Paste same table if more research courses/ workshops have been attended by staff members of your department and please don’t forget to put their respective numbers in the headings as mentioned above.)

III. FOR PERIOD 1ST JANUARY 2016 TILL 31ST













IV. FOR PERIOD 1ST JANUARY 2017 TILL 31ST













Section G –

(A)

ANY AWARD/MEDAL/POSITION SECURED OR ANY OTHER OUTSTANDING

ACCOMPLISHMENT FOR ANY RESEARCH RELATED ACTIVITY OR DURING A

RESEARCH COURSES/ WORKSHOP/CONFERENCE OR

COMPETITION AT INTERNATIONAL LEVEL BY ANY FACULTY MEMBER OF THE

DEPARTMENT I. FOR PERIOD 1ST JANUARY 2014 TILL 31ST

DECEMBER 2014Sl.No Name of

faculty member who secured an award or position

Title of research for which award/position was secured

Name of Award/ Position secured /Accomplishment title

Event Dates

123456

78910

If more than 10 awards/positions, then please include more rows with respected serial numbers in chronological order and if none then write NONE under the heading and delete the empty table






Event Dates

12345678910




faculty member who secured an award or



Event Dates

position12345678910







Event Dates

12345678910


Section G –

(B)

ANY AWARD/MEDAL/POSITION SECURED OR ANY OTHER OUTSTANDING

ACCOMPLISHMENT FOR ANY RESEARCH RELATED ACTIVITY OR DURING A

RESEARCH COURSES/ WORKSHOP/CONFERENCE OR

COMPETITION AT NATIONAL/LOCAL/RMU LEVEL BY ANY FACULTY MEMBER OF

THE DEPARTMENT I. FOR PERIOD 1ST JANUARY 2014 TILL 31ST





Event Dates

123456

78910







Event Dates

12345678910



DECEMBER 2016If more than 10 awards/positions, then please include more rows with respected serial numbers in chronological order and if none then write NONE under the heading and delete the empty table






Event Dates

1234567

Sl.No Name of faculty member who secured an award or position



Event Dates

12345678910

8910


Section H –

(A)

ANY SCHOLARSHIP ATTAINED FOR ANY RESEARCH RELATED ACTIVITY AT

NATIONAL/LOCAL/RMU LEVEL BY ANY FACULTY MEMBER OF THE



faculty member who secured scholarship

Title of research for which scholarship was secured

Name of Scholarship

Amount in Pakistani Rupees

Duration of Scholarship

123456

78910

If more than 10 scholarships, then please include more rows with respected serial numbers in chronological order and if none then write NONE under the heading and delete the empty table





Name of Scholarship



12345678910




faculty member

Title of research for which

Name of Scholarship



who secured scholarship

scholarship was secured

12345678910






Name of Scholarship



12345678910


Section H –

(A)

ANY SCHOLARSHIP ATTAINED FOR ANY RESEARCH RELATED ACTIVITY AT

INTERNATIONAL LEVEL BY ANY FACULTY MEMBER OF THE





Name of Scholarship



12345

678910

If more than 10 scholarships then please include more rows with respected serial numbers in chronological order and if none then write NONE under the heading and delete the empty table





Name of Scholarship



12345678910




faculty Title of research for

Name of Scholarship

Amount in Pakistani


member who secured scholarship

which scholarship was secured

Rupees

12345678910






Name of Scholarship



12345678910


PROFILE OF THE STAFF MEMBER/S OF DEPARTMENT WHO FILLED IN THE PERFORMA

NAME/S

DESIGNATION/S AT THE DEPARTMENT

POSTAL ADDRESS (Official)

TELEPHONE (Landline Office)

TELEPHONE (Mobile)):

Email address:

Signature/s

Name of the Head of Department:

Signaturesof Head of Department:

Date of Submission of Form: DAY-MONTH-YEAR

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