ETR/E/F/03 FILE NO: ETR/M/MC/RP/_________/_______

APPLICATION TO OBTAIN RESEARCH ALLOWANCE AS PER THE

MANAGEMENT SERVICES CIRCULAR NO 02/2014
PART B [To be completed by each applicant separately]

1 Title of the
Research

2 Personal Details of the Applicant

2.1 Status Principal Investigator Co-investigator
2.2 Name with Initials
2.2 Full name

2.3 Designation
2.4 Date of Birth 2.5 Age
2.6 NIC No 2.7 SLMC Reg. No
2.8 Permanent Residential
Address
2.9 Mobile Telephone No 1. 2.
2.10 Residential Tel. No
2.11 Official Tel. No.
2.12 Email Address
3 Details related to the employment
3.1 Academic 1.
Qualifications
2.
3.
4.
3.2 Are you confirmed in Yes 3.3 If not, are you eligible Yes
the service to be confirmed in the
No service No

3.4 Date confirmed/ eligible to be confirmed

3.5 Current place of work

3.6 Designation
3.7 Date of appointment to the current place of work
3.8 Is your salary paid from the current place of work Yes No
3.9 If not, clearly mention
the salary paying
 institution

4 Previous payments of research allowance (both completed and ongoing research) 1

4.1 Title of the Research
Reference Number
Year commenced
Status of research Completed satisfactorily Terminated prematurely
If terminated
prematurely, reason

Last payment date of research allowance for this research

4.2 Title of the Research

Reference Number
Year commenced
Status of research Completed satisfactorily Terminated prematurely
If terminated
prematurely, reason

Last payment date of research allowance for this research

4.3 Title of the Research

Reference Number
Year commenced
Status of research Completed satisfactorily Terminated prematurely
If terminated
prematurely, reason

Last payment date of research allowance for this research

Check List
The following documents are attached to the application
1 Certified copy of National Identity Card (NIC)

2 Certified copy of the Driving License/ Passport (Only when NIC is not available)

3 Certified copy of the salary slip of the last month before submitting the application. (As
evidence of an officer being paid by Ministry of Health)
4 Certified copy of the SLMC Registration Certificate

1
Add separate sheet if space is not adequate
 5 Declaration by the Researcher
 I am currently engaged/ not engaged* in any other research project for which research allowance
is being paid to me
 Provisions under the Consolidated Fund will not be utilized to carry out this research project
 This research project is not carried out as a part of the Annual Action Plan nor as a routine
activity of a government institution nor as a part of a post graduate qualification.
By signing below and submitting this application form, I, ……………………….………………….
……………................. confirm that all the information I have provided in this application is true and
accurate to the best of my knowledge and I further confirm that I understand if any of the information
I have provided is later found to be false or misleading, it renders me ineligible for obtaining research
allowance and also subject to disciplinary measures against me.

Date: …………………………………………………….. ……………………………………………………………………………

Signature of the Applicant

* Delete which is inapplicable.
6 Declaration by the Head of the Institution / Decentralized Unit / Specialized Campaign

I certify that
a. The applicant is an officer belongs to the categories mentioned in paragraph 03 of the
Management Services Circular 02/2014 and is thereby entitled to apply for research
allowance2
b. The applicant is confirmed in the service/ has fulfilled the criteria to be confirmed in the
service
c. The proposed research project would not impede the duties of the permanent post of the
applicant.

Name of the Institution: ………………………………………………………………………………………………………………………..

Date: …………………………………………………….. ……………………………………………………………………………

Name and Signature of the Head of Institution

Date: …………………………………………………….. ……………………………………………………………………………

Name and Signature of Decentralized Unit /

Specialized Campaign

2
Excerpt from the Management Services Circular No 02/2014
03. Officers entitled to the allowance
(I) Officers in Public Service who have been appointed on permanent basis to a “Senior Level” post in
accordance with the definition stipulated in the Public Administration Circular No 06/2006
Deputy Director General (Education, Training & Research)
Ministry of Health

SUBMISSION OF THE APPLICATION FOR THE PAYMENT OF RESEARCH

ALLOWANCE AS PER THE MANAGEMENT SERVICES CIRCULAR NO 02/2014

Herewith, I am submitting the following documents for the above-mentioned purpose:

Part A of the Application

___ sets of Part B of the Application with attachments [One set for each applicant]
Part C of the Application
Part D of the Application (Research Proposal) with attachments
Ethical Approval Letter from ERC ……………………………………………………………………………….
Memorandum of Understanding (If relevant)
Material Transfer Agreement (If relevant)

In addition, I am submitting CD/DVD burned with the following documents

Part D of the Application
All study instruments
All participant information sheets
All consent forms

………………………………………………………………………………………..

Signature of the Principal Investigator/ Corresponding investigator

Name: ………………………………………………………………………….

Date : ………………………………………………………………………….