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To,
Mr. Kunal Banodkar
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 Mr. Kunal Banodkar,
Subject: {{$ActivityName}}
In response to your letter, Classic /IPUP/Sporidex CV/2022 , Dated 16th December 2022,
I agree to participate in the study as outlined by you. I understand that:
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You will provide me with a copy of the study plan, CRF and full prescribing
information on Sporidex CV.
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Sporidex CV will be prescribed and purchased as in my routine practice.
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The patients’ identity will not be disclosed in the CRF.
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I have to report serious adverse events (SAE), if any, immediately to your monitor or
to you in the AE reporting form.
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You will provide the assistance of a monitor to verify the information in the CRF with
that in the patients’ case papers and reports.
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You will pay me by cheque a fee of Rs. 5000 (Rs. Five thousand only) per patient, and
accordingly, on receiving the completed CRFs, of these {{$numberOfPatient}} patient’s, 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.
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