Passion for Innovation. Compassion for Patients.™
Detailed Description of the Programme to include the following information. Please attach any supporting materials.
There is no need to complete all the fields in this section. Complete only those that are relevant to the programme.
If request for funding is in relation to a meeting provide cost of room hire, subsistence, travel, overnight accommodation, communication and materials associated with the event and honoraria (upload in section 7)
If you are requesting funding on behalf of a charitable organisation please provide the following documents with your application.
‘Bribery’ is defined as:‘Giving someone a financial or another advantage to encourage that person to perform their functions or activities improperly or to reward that person for having already done so. So this could cover seeking to influence a decision-maker by giving some kind of extra benefit to that decision maker rather than by what can be legitimately be offered as part of a tender process.’In order to prevent any unwitting engagement in behaviour which might raise the suspicion of bribery each application for a Grant of Donation must be accompanied by a completed ant-bribery assessment form.Please read and act in accordance with the Anti-bribery Act – Click herePlease complete the following questions. Daiichi Sankyo will not be able to review your application for a Grant or Donation unless these are completed.
Please do not use this form to report adverse events. If you experience any adverse effects whilst taking a Daiichi Sankyo product, please report the event to:
Medical DepartmentDaiichi Sankyo UK LimitedChiltern PlaceChalfont Park, Gerrards CrossSL9 0BG0800 028 5122Email: firstname.lastname@example.org
Information on the reporting of adverse events can be obtained from www.yellowcard.gov.uk