STATEMENT LETTER
The undersigned below:
Name :
Institution :
Office Address :
Mobile Phone :
Home Address :
E-mail Address :
I herewith submit 1 (one) research article with the title:
……………………………………………………………………………………………………….
Please note that this article:
1. Is not a result of plagiarism and does not contain elements of plagiarism;
2. Is not being processed for publication in any form;
3. Is not submitted to other periodicals for consideration;
4. All those who have made significant contributions are listed in the ownership line as co-authors and have agreed
to submit the final version of the paper for publication;
5. The author is willing to bear the risk of the accuracy of the data and will not ask accountability to the editor for
errors in the data provided.
Thus, I made this statement truthfully, and I am willing to accept all actions taken by the Editorial Board of Media Karya Kesehatan if later, my statement is proven to be untrue.
Bandung, ………….