Authorship Disclosure Form

Authorship responsibility, financial disclosure, acknowledgement, and copyright transfer/publishing agreement

Each author must read and sign the three statements. In addition, the corresponding author must sign the acknowledgement statement. Make photocopies, if necessary.

Manuscript title:_________________________________________________
First author's name:______________________________________________
Name of corresponding author:_____________________________________

Authorship disclosure

1. As an author of this manuscript, I understand this submitted paper and its content: has not been previously published (abstracts can be excluded); and the manuscript is not under simultaneous consideration by another journal. I certify that I made substantial contributions to the content of the manuscript and I have given final approval of the submitted manuscript.

_____________________ _____________________
Your signature Date

Financial disclosure

( ) I certify that all my affiliations or financial involvement with any organization or entity having a financial interest in, or financial conflict with, the subject matter or materials presented in the manuscript are fully disclosed in an attachment.
( ) I certify that all financial and material support are clearly identified on the title page of the manuscript.
( ) have no relevant financial interest in this manuscript.

_____________________ _____________________
Your signature Date

Copyright transfer agreement

The author(s) undersigned hereby transfer(s), assign (s), or otherwise convey (s) all copyright ownership, including any and all rights to Dementia top Neuropsychologia.

_____________________ _____________________
Your signature Date

Model of cover-letter
We, the undersigned, authors of the manuscript ______________________________ assume responsibility for the content therein and for its originality, hereby declaring that it was exclusively submitted to Dementia & Neuropsychologia and to no other periodical.

Author's name:_________________________________________________
Full address:___________________________________________________
Email (each author):_____________________________________________


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