Universiti Kuala Lumpur MICET

Lot 1988, Kawasan Perindustrian Bandar Vendor, Taboh Naning,

78000, Alor Gajah, Melaka
Email: wkhairul.dris@s.unikl.edu.my
Tel. number: 011-14945138

Title: Study of Plastic Waste: Recycling System in Malaysia

Consent Form for Interviews

Thank you for reading the information sheet about the interview sub-study. If you are happy to
participate then please complete and sign the form below. Please tick the boxes below to confirm that
you agree with each statement:
Please tick
the box:
I confirm that I have read and understood the information sheet dated [21/02/2019] and
have had the opportunity to ask questions.

I understand that my participation is voluntary and that I am free to withdraw at any time
without giving any reason and without there being any negative consequences. In addition,
should I not wish to answer any particular question or questions, I am free to decline.

I understand that my responses will be kept strictly confidential and my name will not be
linked with the research materials, and will not be identified or identifiable in the report
or reports that result from the research if I wish to do so.

I agree for this interview to be recorded. I understand that the video recording made of
this interview will be used only for analysis and that extracts from the interview. I
understand that no other use will be made of the recording without my written permission

I agree that my anonymised data will be kept for future research purposes such as
publications related to this study after the completion of the study.

I agree to take part in this interview.

________________________ ________________ ___________________

Name of participant Date Signature

_________________________ __________________ _____________________

Investigator Date Signature

Copies: Once this has been signed by all parties the participant should receive a copy of the
signed and dated participant consent form, and the information sheet.

Participant interview consent form, dated 21/02/2019 Page 1