REC Standard Form No.

16A
ICF Evaluation Version No. 01
New ICF Date of Effectivity 01 Jan 22

Part 1: To be filled up by the Principal Investigator

UVREC Code: Date Submitted:
Protocol No:
Protocol Title: THE CLIENT PERSPECTIVE OF MOBILE BANKING SERVICE IN CEBU CITY
Site Address: UNIVERSITY OF THE VISAYAS – COLON STREET, CEBU CITY
Principal Investigator: Research Adviser:
GRACELYN D. SOJOR PHILIP M. ALMANON, MBA
Email Address: gracelyn_sojor@uv.edu.ph Contact No: 09551136445

Part 2: To be filled up by the ICF Reviewer

GUIDE FOR REVIEWING THE INFORM CONSENT PROCESS & FORM

1. There is a need to seek the Informed Consent of the participants.
( ) YES ( ) NO ( ) CANNOT TELL
If NO, please explain
If YES, the participants provided with sufficient information about the following items:
YES NO
o Purpose of the study
o Expected duration of participation
o Procedure to be carried out
o Discomforts and inconvenience
o Risks (including possible discrimination)
o Benefits to the participants
o Compensation and/or medical treatment in case of injury
o Contact person in case of questions for assistance in research-related concerns or injury
o Extent of confidentiality
2. The Informed Consent is written and is presented in non-technical language that participants can understand.
( ) YES ( ) NO ( ) CANNOT TELL

3. The protocol includes adequate process for ensuring that the consent is voluntary.
( ) YES ( ) NO ( ) CANNOT TELL
4. There are different types of consent forms (assent, patient representative) appropriate for the types of study
participants.
( ) YES ( ) NO ( ) CANNOT TELL
5. The names and contact numbers of the research team and UVREC are in the informed consent.
( ) YES ( ) NO ( ) CANNOT TELL
6. The Informed Consent is translated into the local language/dialect. (if applicable)
( ) YES ( ) NO ( ) CANNOT TELL
7. OVERALL SUGGESTIONS

RECOMMENDATION: ( ) APPROVED
 ( ) Minor Revisions Required
____________________________________________________
____________________________________________________

( ) Major Revisions Required, Need for Resubmission

____________________________________________________
____________________________________________________

( ) DISAPPROVED

Reasons for disapproval:

_______________________________________________ ____________________________
Signature over Printed Name of the Reviewer Date Reviewed