There are no companies, etc. in a relation of conflict of interest requiring

disclosure in relation to the presentation.

Form1 （ Example : If there is NO state of conflict of interest requiring disclosure ）

18th WCBIP/WCBE COI Disclosure

　

　 Name of Lead Presenter: __________________

Form2 (Example: If there is a state of conflict of interest requiring disclosure)

18th WCBIP/WCBE COI Disclosure

Name : __________________

Companies, etc. in a relation of conflict of interest requiring disclosure in relation to the presentation:1. Advisor: PPP Pharmaceutical Industries

(*Indicate "None" if not applicable.)2. Stock ownership/capital gain: QQQ Pharmaceuticals

(*Indicate "None" if not applicable.)3. Patent royalties: RRR Pharmaceutical Industries

(*Indicate "None" if not applicable.)4. Honoraria: SSS Pharmaceuticals, TTT Pharma

(*Indicate "None" if not applicable.)5. Writing fees: UUU Pharmaceutical Industries

(*Indicate "None" if not applicable.)6. Grants for commissioned/joint research: VVV Pharmaceuticals

(*Indicate "None" if not applicable.)7. Scholarship grants: XXX Pharmaceuticals

(*Indicate "None" if not applicable.)8. Endowed chair: YYY Pharmaceuticals

(*Indicate "None" if not applicable.)9. Gifts or other forms of compensation: ZZZ Pharmaceutical Industries

(*Indicate "None" if not applicable.)