Pre-disclosure form for paper co-authorship with a specially related person

Study overview

Paper name
Author information (※ Add according to number of authors)	Specially related person	Name
		Affiliation
		Position
		Role		□ First author □ Corresponding author □ Co-author
		Contact	Phone
			Phone
	Author 1	Name
		Affiliation
		Position
		Role		□ First author □ Corresponding author □ Co-author
		Whether related		□ Yes □ No
		Contact	Phone
			Email
	Author 2	Name
		Affiliation
		Position
		Role		□ First author □ Corresponding author □ Co-author
		Whether related		□ Yes □ No
		Contact	Phone
			Email
	Author 3	Name
		Affiliation
		Position
		Role		□ First author □ Corresponding author □ Co-author
		Whether related		□ Yes □ No
		Contact	Phone
			Email
Research fund supporting organization (※Add according to the number of supporting organizations)	Organization name			Project number

Type of specially related person (Mark ○ in all appropriate fields)

Family (within fourth degree of kinship)			Minor
Spouse	Children	Other	Acquaintance’s children	Program participant	Other

Reasons for a specially related person to be included as the author of the above paper

※ A remodeled description of the contribution of a specially related person to the achievement of the above     paper

Describe the contribution at each stage of the research (summary)

Category	A. Research plan (Research design, conceptualization of work)	B. Research (Research data collection/analysis/interpretation, basic manuscript preparation)	C. Draft manuscript (Draft or critically revise important content)	D. Final manuscript confirmation (Final review and approval of the paper)	E. Contribution level (%) (A+B+C+D)	Confirmation signature
Specially related person	( )%	( )%	( )%	( )%	( )%
Author 1	( )%	( )%	( )%	( )%	( )%
Author 2	( )%	( )%	( )%	( )%	( )%
Author 3	( )%	( )%	( )%	( )%	( )%
Total contribution by author					100

Year     Month     Day

I confirm that all of the above is true.

	Author name	Confirmation signature
Specially related person
Author 1
Author 2
Author 3