Annex B

APPLICATION FOR AUTHORIZATION

(For the Conduct of Scientific Procedures Using Animals)
1. Name of Entity: PITAK_______________________________________________
2. Address : Mabini Street, Ugac Norte, Tuguegarao City_______________________
_________________________________________________________________
3. Telephone Nos. : ____n/a_________________ Fax Nos.: ___n/a____________
4. Name and Position of Representative Person:
Magallanes, Edward Lugaya_______________________________________
Last Name First Name Middle Name
Position : Research Adviser______________________________________________
5. Description/Profile of Entity (attach organizational chart):
6. Purposes of the conduct of Scientific Procedures (encircle one or more):
a. Biomedical research, experiment, studies, investigation (including preclinical research)
b. Teaching and instruction
c. Product testing
d. Production of antisera or other biologicals
7. Identify the Key Institutional Representatives (including the ACUC Chairperson,
veterinarians, and researchers):
I certify that the statements made herein are correct and true.
___________________________________________________________________
Signature of representative Signature of head of Institution
Date: March 9, 2018_____________ Date: March 9, 2018_______________
Note: This application should be accompanied by the requirements stipulated in Section four of
the Administrative Order.
Appendix 1.
ANIMAL CARE AND USE STATEMENT
(Protocol Review Form)
I. PROCEDURE(S) OR TITLE OF RESEARCH/STUDY:
 The efficacy of Lanzones seed as a blood sugar regulator.
II. PURPOSE/OBJECTIVES:
 This study aims to gauge the effectiveness of powdered Lanzones seeds as
blood sugar regulator.
III. DURATION OR TIME FRAME:
 From March 8-June 29, 2018
IV. RESPONSIBLE PERSON OR PRINCIPAL INVESTIGATOR:
A. NAME: Edward L. Magallanes
B. QUALIFICATION (degree(s) or training experience)
V. BACKGROUND AND SIGNIFICANCE OF THE PROCEDURE OR RESEARCH:
Lanzones is a tree growing to a height of 4 to 15 meters. Leaves are alternate. 20 to 40
centimeters long, with 5 to 7 leaflets, oblong to oblong-elliptic, 7 to 18 centimeters in length, and
pointed in both ends. Flowers are small, yellow and borne on spikes, solitary or fascicled on the
trunk or larger branches. Fruit is yellowish-white, occurring in bunches in a single stem, ellipsoid
or globose, 2 to 4 centimeters long, with bitter seeds that are surrounded by translucent pulp
(arillus). The outer skin is thin and tough, abundant in a milky juice. The pulp occurs in five
sections with one well-developed seed. Lanzones peels can be used as natural mosquito
repellents. Drying and burning the rind produces a smell that repels mosquitoes. Dried Lanzones
rinds contain anon-toxic resin proven to stop diarrhea, intestinal spasms are also reduced. Dried
Lanzones peels contain five onoceroid triterpenes known to have an antibacterial effect. These
are believed to fight bacterium such as C albicans, P. aeruginosa and B subtilis.

With this, the researchers thought of coming up with powdered Lanzones seeds for
regulating blood sugar levels. In this way, we can have a possible substitute for commercially-
produced anti-inflammatory product that is not very costly but effective.

VI. DESCRIPTION OF METHODOLOGIES/EXPERIMENTAL DESIGN:

This section should establish that the proposed procedures/research are well
designed scientifically and ethically. The following should be indicated or
described:
A. Type of animal to be used (species)
 Albino Rats
B. Source of the animals
 Isabela
C. Reason/basis for selecting the animal species
 It is commonly used in laboratory experiments.
D. Sex and number of animals (justify the number of animals)
 1 male and 1 female for breeding.
E. Quarantine and/or acclimation or conditioning process
 The Albino rats will be quarantined together for 1 month.
F. Animal care procedures
 The Albino rats will be fed, cleaned, and check regularly to ensure cleanliness
and protection.
1. Cage type
 Closed cage
2. Number of animals per cage
 2 Albino rats per cage (1 male and 1 Female)
3. Cage cleaning method
 Three times a week (Monday, Wednesday, Saturday)
4. Room temperature, humidity, ventilation and lighting
 The room temperature is 20℃, well ventilated and has a good lighting.
5. Animal diet and feeding and watering method
 The Albino Rats will be fed with pellets. The food will be checked and
replace regularly as well as the water. The water used is distilled water to
avoid contamination.
I. Indicate the names and qualification of all personnel who will be
responsible for conducting the procedures.
VII. DECLARATION BY THE RESPONSIBLE PERSON:

I ACCEPT RESPONSIBILITY FOR ASSURING THAT THE PROCEDURES/

STUDY WILL BE CONDUCTED IN ACCORDANCE WITH THE
APPROVED PROTOCOL.
I ASSURE THAT ALL PERSONNEL WHO USE THIS PROTOCOL AND
WORK WITH ANIMALS HAVE RECEIVED APPROPRIATE TRAINING/
INSTRUCTIONS IN PROCEDURAL AND HANDLING TECHNIQUES, AND
ON ANIMAL WELFARE CONSIDERATIONS.
I AGREE TO OBTAIN WRITTEN APPROVAL FROM THE INSTITUTIONAL
ANIMAL CARE AND USE COMMITTEE PRIOR TO MAKING ANY
CHANGES AFFECTING MY PROTOCOL. I ALSO AGREE TO PROMPTLY
NOTIFY THE IACUC IN WRITING OF ANY EMERGENT RPOBLEMS
THAT MAY ARISE IN THE COURSE OF THIS STUDY, INCLUDING THE
OCCURRENCE OF ADVERSE SIDE EFFECTS.
Signature of the Responsible Person:
Edward L. Magallanes____________________ Date: March 9, 2018___________
Noted by the IACUC Chairman
Mrs. Anita C. Capiral_____________________ Date: March 9, 2018 __________