Purpose

This declaration confirms the understanding between the patient and Colpitts Clinical regarding stipend payments made in connection with participation in a clinical study.

Declaration

I acknowledge receipt of stipend payments related to my participation in a clinical study.
These payments are made by Colpitts Clinical, a UK-based company, on behalf of the study sponsor. The purpose of these payments is to provide compensation for time and inconvenience associated with study participation.

I understand and agree to the following:

1. These payments are not employment income and do not create any employment relationship.
2. It is my personal responsibility to declare these payments to the appropriate tax authority in my country of residence, if required by law.
3. Colpitts Clinical, the study sponsor, and the clinical site are not responsible for reporting these payments to local tax authorities on my behalf.
4. Payments will be made in accordance with the study’s approved stipend schedule and applicable regulations.

Data Protection Notice (GDPR Compliance)

Colpitts Clinical will process and store your personal data (such as name, contact information, and payment details) solely for the purpose of administering clinical trial travel and reimbursement services.

Your data will be handled in compliance with the UK GDPR and any applicable local privacy laws. You have the right to access, correct, or request deletion of your personal data at any time by contacting ColpittsPrivacy@dt.com.

* Required fields