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To,
The Chairperson,
Institutional Ethics Committee (Human Research*/ Animal Research *),
L.T.M.M.C. & L.T.M.G.H.,
Sion, Mumbai-400 022.

Subject :   Submission of Clinical Study Documents for sponsored* / Not sponsored* for your review and approval.

Sir/Madam,

I request you to kindly accept my application for the project Titled “<     >” which is multinational* / multi centric */ unicentric *study,  so as to enable me to conduct the referenced research project  at Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai, if granted permission by the Institution Ethics Committee. I will be responsible towards  the co investigators for this project.

The total number of patients that is proposed to be enrolled is “<   >” over a period of “ <   >” which will be feasible at the Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai in the above period.
( If Multicentric/ Multinational  study then please specify as below)*
 The total number of patients planned to be enrolled for all the centres are “<   >” and for  the centres In India  are “<   >”

The study is not sponsored / Sponsored *
( If Sponsored please specify as below)*
The study is Sponsored by “<   >” located at “<    >” and will be represented by “<     >”. The sponsorer is a Pharmaceutical/Biotech Company/ Contract Research Organization (CRO)/ ICMR/ Other – “<please specify>”

Please find enclosed herein following documents for your review and approval.

I would be happy to offer any other information or clarification as may be required by you

Thanking you.

Dr.   “<    > “
“<Designation>”  
Dept. of “<     >”
Mobile No.  “<   >”
L.T.M.Medical College & L.T.M.G. Hospital,
Sion, Mumbai 400 022.

•  * Please select and type the correct option
  “<     >” Please provide required information