Request for Materials Transfer
Date:

mm/dd/yyyy

To: 学部長、所長等のタイトル（例：Dean of The Institute of Medical Science）, The
University of Tokyo

As an authorized official in [the name of recipient institution], I request you and Provider Researcher
to furnish the following Research Material(s) listed hereunder, and I hereby understand and agree tothe following:

Povider Researcher:
Name:
Title :
Faculty:
Address:
Phone:,Fax:

e-mail:Research Material(s):[to specify Subject Material]
Recipient Researcher:
Name:
Title :
Institution:
Address:e-mail:The Purpose of the Research :Terms and Conditions:
Research Material(s) shall be used under the following terms and conditions:
1. Research Material(s) are used only for the research project(s) that are described above as thePurpose of the Research. We will not use Research Material(s) for purposes other than that
proposed Purpose of the Research in this letter, without your permission.
2.

Research Material(s) will be received by our Recipient Researcher only for use in ourlaboratory. We will not pass Research Material(s), their progeny or unmodified derivatives, on
to any other party or use them for commercial purposes without the express written consent ofyou.

If we will collaborate with any other person outside of our laboratory using ResearchMaterial(s), we will inform you and ask your permission.
3.

When the research project is completed, or when Recipient Researcher moves to anotherinstitution or retires, Research Material(s), their progeny or unmodified derivatives, shall be
destroyed immediately.

4.

If we want to use Research Material(s) for the development or evaluation of commerciallyvaluable products, we will ask your permission prior to the use.

5.

We will pay a Fee for Research Material(s) including shipping and handling cost in yourUniversity, according to your invoice which indicates the amounts, the due date and the bankaccount for the wire transfer, bearing the charged bank commission, together with theconsumption tax for that amount.

Fee ( including applicable tax)

6. We understand that no other right or license to Research Material(s), their progeny or unmodified
derivatives, is granted or implied as a result of Research Material(s) transfer.
7. We acknowledge and understand that Research Material(s) is experimental in nature and may
have hazardous properties and that you and Provider Researcher make no warranties of any kind,either expressed or implied. We also acknowledge and understand that there are no express orimplied warranties of merchantability or fitness for a particular purpose, or the use of ResearchMaterial(s) will not infringe any patent, copyright, trademark or other proprietary rights.
8. We will acknowledge Provider Researcher’s contribution as a provider of Research Material(s)in our publication relating to Research Material(s) and will provide one copy of such publication
to you.
9. We will inform you of any patent application relating to Research Material(s) if applied for.
10. We will follow the requirement of applicable laws, rules and regulations.

Duly, I, the undersigned, agree and pledge as follows;（Authorized Official）

Signature:
Name:
Title :
Institution:
Address:
Date:

As Recipient Researcher of Research Material(s), I have read this request and acknowledge andunderstand its provisions.
Signature:
Name:
Title:
Date:

Note: ( Used by The University of Tokyo )If you agree to furnish these materials under the above terms and conditions, please sign this letter,and then return copy of this letter to the recipient institution.

ACCEPTED:事務部長の署名

Date :

署名日

Date :

署名日

事務部長氏名、タイトル、学部等
Provider Researcher:
提供者の署名
提供者氏名