Date: {{$ActivityAssignDate}}

To,


Mr. M. Sundarrajan

Sun Pharmaceutical Industries Ltd.

Sun House, CTS No. 201 B/1,

Western Express Highway, Goregaon (E),

Mumbai - 400 063; Tel: + 91 22 4324 1234/4324

Dear Dear Mr. M. Sundarrajan


Subject : In-Practice Usage and Performance (IPUP) Study of ROLES


In response to your letter, IPUP/ROLES/Stanlife /April 2023 dated 20th April, 2023, I agree to participate in the study as outlined by you.
I understand that:


  • You will provide me with a copy of the study plan, CRF and full prescribing information ROLES.

  • ROLES will be prescribed and purchased as in my routine practice.

  • The patients’ identity will not be disclosed in the CRF.

  • I have to report serious adverse events (SAE), if any, immediately to your monitor or to you in the AE reporting form.

  • You will provide the assistance of a monitor to verify the information in the CRF with that in the patients’ case papers and reports.

  • You will pay me by cheque a fee of Rs. 2000 (Rs Two thousand only) per patient, and accordingly, on receiving the completed CRFs, of these patients, as a compensation for the extra time spent in record keeping. The cheque for fee may be drawn in favor of

    • “………………………………………………………………………………………………………………………………………………………………..”

My personal details are given below for accuracy of your records.

Name:* {{$doctorName}}
Qualifications:
Specialty
Postal Address:
PIN Code :
Clinic/Hospital Tel. No.:
Mobile Number :*
PAN Card Number:*

Please attach a copy of your PAN card for Administrative records


Yours sincerely,

[Signature]
{{$doctorName}}