4. Comments/Remarks: (To be filled by IAEC-member)
Investigator signature IAEC-MEMBER Signature
BRIEF SUMMARY OF THE PROJECT
(ONE PARAGRAPH IN LAYMAN’S TERM)
Form B (per rule 8(a)
APPLICATION FOR PERMISSION FOR ANIMAL EXPERIMENTS
Application to be submitted to sent either to the CPCSEA (address in form A above) or Institutional Animal Ethics Committee (IAEC)
Part A
1*
Name and address of establishment
2*
Registration number and date of registration
3
Name, address and registration number of breeder from which animals acquired (or to be acquired) for experiments mentioned in parts B & C
4
Place where the animals are presently kept (or proposed to be kept)
5
Place where the experiment is to be performed (Please provide CPCEA Reg. Number)
6
Date on which the experiment is to commence and duration of experiment
7
Type of research involved (Basic Research/Educational/Regulatory)
Signature Name and designation of Investigator Date: Place:
*Applicable only for application to be submitted to CPCSEA
PART B
Protocol form for research proposals to be submitted to the committee/Institutional Animal Ethics Committee, for new experiments or extensions of ongoing experiments using animals other than non-human primates.
1. Project / Dissertation / Thesis Title:
2. Principal Investigator / Research Scholar / Research Guide /Advisor :
a. Name
b. Designation
c. Dept / Div/ Lab
d. Telephone No.
e. Experience
3. List of names of all individuals authorized to conduct procedures under this proposal Co -guides
a. Name
b. Address
c. Experience
4. Funding source with complete address (Please attach the proof)
5. Duration of the project
a. Number of months
b. Date of initiation (Proposed)
c. Date of completion (Proposed)
6. Detailed study plan may be given (Not more than one page)
7. Animals required
a. Species/Common name
b. Age / weight / size
c. Gender
d. Number to be used (Year-wise breakups and total figures needed to be given)
e. Number of days each animal will be housed.
f. Proposed source of animals
8. Rationale for animal usage
a. Why is animal usage necessary for these studies?
b. Why are the particular species selected required?
c. Why is the estimated number of animals essential?
d. Are similar experiments conducted in the past? If so, the number of animals used and results obtained in brief.
e. If yes, why new experiment is required?
f. Have similar experiments been made by any other organization agency? If so, their results in your knowledge.
9. Description the procedures to be used.
List and describe all invasive and potentially stress full non-invasive procedures that animals will be subjected to in the course of the experiments.
Furnish details of injections schedule
Substances:
:
Doses
:
Sites
:
Volumes
:
Blood withdrawal
Volume
:
Sites
:
Radiation
(dosage and schedule)
:
10. Please provide brief descriptions of similar studies from invitro/invivo (from other animal models) on same/similar test component or line of research. If, enough information is available, justify the proposed reasons.
