Annals of Vascular Diseases
Conflict of Interest Disclosure Statement
Author Name:
Manuscript Title:
Date:
■ When submitting a manuscript to Annals of Vascular Diseases, all authors are required to disclose any financial
relationship with a biotechnology manufacturer, a pharmaceutical company, or other commercial entity that has an
interest in the subject matter or materials discussed in the manuscript.
■ Conflict of Interest should be disclosed both by 1) submitting this disclosure statement form and 2) adding the
statement in the submitted manuscript.
1) Each author is required to complete this form regarding yourself, your spouse, or other immediate family member)
and return it to the corresponding author. The corresponding author should upload all the forms onto online
submission/peer-review system (Editorial Manager) when submitting a manuscript.
Categories
1. Employment/Leadership
Amount
Yes or No
Entities
1,000,000 JPY or more
Yes/No
position/Advisory role
2. Stock ownership
1,000,000
JPY
or
more
profit
Yes/No
5% or more shareholding
3. Patent royalties/licensing
1,000,000 JPY or more
Yes/No
fees
4. Honoraria (e.g. lecture
1,000,000 JPY or more
Yes/No
fees)
5. Fees for promotional
1,000,000 JPY or more
Yes/No
materials or manuscript fee
6. Research funding
2,000,000 JPY or more
7. Scholarship/Donation
2,000,000 JPY or more
8. Endowed chair
-
9. Travel expenses/Gift
50,000 JPY or more
Yes/No
Yes/No
Yes/No
Yes/No
2) Example of Disclosure Statement on the Manuscript (This should be written before References section.)
Disclosure Statement
A (author name) serves as a consultant to Z (entity name); B’s spouse is chairman of Y; C received a
research grant from X; D received lecture fees from V; E holds a patent on U; F has been reimbursed by T
for attending several conferences; G received honoraria for writing promotional material for S; H has no
conflict of interest.; All authors have no conflict of interest.