Sample COI Disclosure Forms

Last Updated: Dec 11, 2020
 
The Conflict of Interest Disclosure form can be accessed herePlease ensure that only one tick box is selected, that company names are clearly indicated for each affiliation type and that the form is signed digitally via an eSignature or by hand. Typed signatures will not be accepted. Click on the two sample forms below to view it close up. 
 

    
 
 
Windows
 
We recommend using Adobe Acrobat X Pro. Click on "Tools" on the right top corner. Should there be issues with the "Sign Document" function, select "Apply Ink Signature" found under "Sign & Certify" to sign the disclosure form. Depending on the software version, the interface may appear slightly different. A step-by-step tutorial can be accessed here 
 
 
 
 
Macintosh 
 
We recommend using Preview. Click on the Markup Toolbar button (a pencil icon that looks like the capital A), then select the signature icon to create a signature using your mouse or trackpad. A step-by-step tutorial can be accessed here
 
 
 
Troubleshooting
 
If you encounter any issues or have questions filling out the form, please write to scientific.programme@siu-urology.org with your computer type (Windows, Macintosh, Linux) and available pdf reading software (Adobe Acrobat Pro, Preview). You may also choose to print out the form and fill it out by hand.