Transfer of Copyright Agreement, Conflict of Interest Acknowledgement, Certification of Co-author’s, Exclusive Publication

Statement, and Disclosure of Commercial Interest to Indian Journal of Dental Research

(This form must be signed by all the authors, scanned as PDF Version & uploaded in submission site)
(This agreement must be signed by ALL authors in order for the manuscript to be uploaded)

For the article titled: Soft Tissue Compensations in Various Skeletal Malocclusions – A Cephalometric Study.

submitted on_____________________

(Herein, “the article”) is hereby transferred to the Indian Journal of Dental Research (IJDR) (for any Government
employees/funding agencies to the extent transferable and mutually agreed upon), effective if and when the article is
accepted for publication in the IJDR. Authors who are supported in whole or in part by the public funding agencies should
contact the IJDR to facilitate compliance with the funding agencies deposit policy. The copyright that the authors assign to the
IJDR encompasses all rights to exploit the article in any manner throughout the world. These rights include, but are not
limited to, all print reproduction and publication rights and electronic publication rights, such as CD-ROM and online
publication, as well as dissemination by any technology now known or later devised. The author(s) grant permission to IJDR
republish the article in whole or in part, with or without fee; the right to produce preprints or reprints and translate into
languages other than English for sale or free distribution; the right to republish the work in a collection of articles in any other
mechanical or electronic format.

The author(s) shall retain all patent and other proprietary rights to the article. If an author wishes to reproduce the article,
fully or in part including photographs, images, infographics or such, in any medium for distribution (commercial) purposes,
the author must obtain permission from the IJDR/Publishers as applicable and, if permission is granted, the author must
credit the original source of publication when the article is reproduced. For personal and educative purpose, citation to
source is essential.

The author(s) certify that:

1. The article does not infringe any personal or proprietary rights of others;
2. The editor of the IJDR has been informed of any proprietary or commercial interest or conflicts of interest the author(s)
may have that related directly or indirectly to the subject of this article. This information has been declared in the cover
letter submitted with the article and disclosed below.
3. The scientific content of clinical (except masking identity), radiological & histopathological images have NOT been
altered, and that disclosure has been made regarding computer enhancement or other electronic manipulation (If any).
4. Appropriate permission for disclosure to be obtained from patients and details need to be shared in designated format.
5. Each author(s) have made substantive and specific intellectual contributions to this article and assume full responsibility
for its content, conception and design of this work or the analysis and interpretation of the data (when applicable), as
well as the writing of the manuscript, to take public responsibility for it and have agreed to have my/our name listed as a
contributor. The role of each author has been detailed in the separate file as required.
6. I/We as author(s) believe the manuscript represents a valid scientific work. Neither this manuscript nor one with
substantially similar content under my/our authorship has been published or is being considered for publication
elsewhere, except as described in the covering letter.
7. I/ We author(s) certify that all the data collected during the study is presented in this manuscript and no data from the
study has been or will be published separately. I/We attest that, if requested by the editors or any authorized person by
the IJDR will provide the data/information or will cooperate fully in obtaining and providing the data/information on
which the manuscript is based, for examination by the editors or their assignees.
8. Sources of outside support of the project are named in the cover letter and if nothing is declared, no substantial
contribution is obtained.
9. I/ We would store all the data (as applicable) related to manuscript for at least a period of 5 years from date of
publication and willingly submit to scrutiny of the Editor-in-Chief or a committee constituted for overseeing the data.
10. I/We authors transfer the rights to the corresponding author (as mentioned in first page) to make necessary changes as
per the request of the journal, do the rest of the correspondence on all author(s) behalf and he/she will act as the
guarantor for the manuscript on author(s) behalf.
Name and email of Corresponding author: Dr. Sharmila Arjunan. sharmila_arjunan@yahoo.co.in
11. All persons who have made substantial contributions to the work reported in the manuscript, but who are not authors,
are named in the Acknowledgment and have given us their written permission to be named. If I/we do not include an

Indian Journal of Dental Research; Mandatory Forms; Please use only Blue Pen to sign. Submit as PDF/JPEG copies only
 acknowledgment that means I/we have not received substantial contributions from non-authors and no author has been
omitted. The order and list of author(s) is NOT time bound and is forever applicable.
12. Has acquired necessary permission and adhered to the Institutional Ethical Committee or the review board or any similar
board with competent authority. All proper procedure and documentation has been followed and willing to be shared on
request by the editor(s) or their assignee.
13. The manuscript has been NOT plagiarized and confirms to policies of ICMJE/ IJDR.
14. This agreement has been voluntarily, manually signed by all the authors who contributed to the above mentioned
article.
Disclosure of Commercial Interest and Financial Relationship (Relationships in which the individual benefits by receiving a
salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other
ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated
with roles such as employment, management position, independent contractor, (including contracted research), consulting,
speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from
which remuneration is received or expected. The IJDR considers relationships of the person involved in the activity to include
financial relationships of a spouse or partner or immediate family member)
I/we, or a member of my/our immediate family, do not have and have not had within the past 12 months a financial
interest or other relationship with a commercial organization that may have an interest in the content of the educational
activity.
I/we or a member of my/our immediate family now has or within the past 12 months has had a financial interest or
other relationship with a commercial organization that may have an interest in the content of the educational activity. Please
be specific (i.e., commercial interest, clinical/non-clinical, research grant, research contract, speakers’ bureau, stocks/bonds
[not mutual funds], consultant and other offices/board). If any, please list the manufacturers and/or service providers with
whom you have a financial relationship, and describe the nature of your relationship. Please be specific:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
____________________________ (may add Annexure as applicable)

(All fields to be compulsorily filled by the author/co-author him/herself in blue colour ONLY; Order of the authorship strictly to apply)

No. Name Email ID Mobile number Signature with date

1.

Maximum 4 authors for case reports/technical note/ innovation; 6 for Research studies. Read Instruction to Authors for clarification

Indian Journal of Dental Research; Mandatory Forms; Please use only Blue Pen to sign. Submit as PDF/JPEG copies only
 Authorship Role Declaration form (to be submitted separately)

Manuscript Title:_______________________________________________________________________________________

Contributor Contributor Contributor Contributor Contributor Contributor

1 2 3 4 5 6
Name

Principal Investigator
Responsible Author
Concept
Research Design
Definition of intellectual
content
Literature search
Experiment conducted by
IRB clearance obtained by
Data acquisition
Data analysis
Statistical analysis
Manuscript preparation
Manuscript editing
Manuscript review/
Approval of the draf
Guarantor
Responsibility of storage of
Data
Corresponding author
Conflict of Interest, if any Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No

Initials of Author

Please Tick appropriately; If lef blank, assumed that there is no role. Once Submitted cannot be altered without consent of all authors in writing... Refer to IJDR Authorship
Credits and current ICMJE Guidelines... Please Insert NA, If the column is NOT APPLICABLE

Signature of the Guarantor

Indian Journal of Dental Research; Mandatory Forms; Please use only Blue Pen to sign. Submit as PDF/JPEG copies only
 Patient Image Release/Consent Form

(For all Patient identify related/ownership material reproduction including but not limited to Videos; Photographs/X-rays/Models)

I, Mr./Mrs/ Ms. _________________________________ Son of/ Daughter of/ Wife of Mr./Mrs./Ms.___________ ________
Authorize Prof./Dr. _____________________________ of _____________________________________ [ Institute, Place] to take
and reproduce photographs/video/Models/ Imaging of my face or body for purpose of recording and probable use of the
same in Medical publication in Indian Journal of Dental Research.
(State purpose of use or disclosure of information, if apart from above)

Information to be used or disclosed: Photographs, video and/or electronic media.

Expiration of Authorization:
This authorization expires on (date) OR when the following event occurs:_________________________

By signing this page, I acknowledge that I have read this form/ content has been read and explained to me in
detail. Also, I have been explained that the images/videos/models/ x-rays will be published in Indian Journal of
Dental Research with/without adequate masking the identity.

Signature Date
(Patient or Person Authorized To Give Authorization)
If signed by person other than patient, print name, provide reason, relationship to patient, and description of their authority

Signature of the Doctor Place Date:

Note:
A request to revoke this authorization will not affect any actions already taken based on the original authorization, or
prevent treatment that you receive.
If subject is not fluent in English the contents must be explained in vernacular language, before consent is obtained
If subject is a minor, parent/ legal guardian is expected to complete this form
I understand I have the right to:
• Receive a copy of this signed form
• Refuse to sign this form for authorization to disclose or release my protected health information

Indian Journal of Dental Research; Mandatory Forms; Please use only Blue Pen to sign. Submit as PDF/JPEG copies only