FY 2024 Self-Report on Conflict of Interest
Period covered

April 1, 2023 - March 31, 2025 (Including anticipated future financial interest / activities)※Please make sure to subumit answering Q1 and Q7 even if you are not relevant to conflict of interest.
To the Chairperson of Conflict of Interest Committee, University of the Ryukyus
I here by report the conflict of interest related to academia-industry collaborations based on article 22, Conflict of Intereset Management Provision.
DateMonthYear

Affiliation(Faculty)Day(Department)

Job title
Name
Please answer the following questions about academia-industry collaborations in which you or your husband/wife, parents, and sons/daughters have beenengaged, or plan to do. The collaborations are provided for in Article 3, Self-Report Implementation Guidelines about Conflict of Interest in University of theRyukyus.

Academia-industry collaborations you have been engaged in, or plan to do※Please choose number 1 or 2

Q１. Have you been engaged in any academia-industry collaborations in FY2023 and FY2024, or do you have any plans of them in FY 2024?
１．Yes

Please answer Q2 - Q7

２. No

Please answer Q7

AnswerAcademia-industry collaborations include side jobs (part-time instructor included), lectures, writing manuscripts, consultants, beingexecutives, possession of equities, collaborative researches, consigned researches, contributions, research grants, Health andLaborscience Rsearch grants, occupational injury clinical research operating expenses, Japan Agency for nedical Research andDvelopment(AMED),private donation maintained courses, licenses or transfers of intellectual property rights, acceptances of visiting
researchers and postdoctoral researchers, and device supplies.
※Please choose "2. No" if you have received/are going to receive only
medical treatment fees.

Q２. Do you earn over 1 million yen in a year from the same company or organization by income, side jobs (part-time instructor included),lectures, writing manuscripts, consultants, or royalties? (Excluding medical treatment fees)※Companies and organizations include private companies, general incorporated association, julidical foundation, nation, local public organizaions,
independent administrative institutions, medical corporations, educational foundations, incorporated nonprofit organizations (NPO) and national research anddevelopment agency.

１. YesFill out TableA

２. NoAnswer

Q３. Are you involved with management (being an executive, an advisor or a consultant) of any companies or organizations which are related toacademia-industry collaborations?

１. YesFill out Table A

２. NoAnswer

Q４. Do you own any equities※ of the other parties in academia-industry collaborations?
※Equity means listed/unlisted shares, funds, stock options, and beneficial interests.
※In terms of listed shares, answer "1. Yes" if you own more than 5% of outstanding shares from the same organization.

１. YesFill out Table A

２. NoAnswer

Q５. Have you received more than 2 million yen altogether in a year(Including this year's plan) from the same company or organizaiton inacademia-industry collaborations? The collaborations include cooperative researches, contract researches, contributions, research grants,
private donation maintained courses, commissioner, licenses or transfers of intellectual property rights, technical training, acceptances ofvisiting researchers and postdoctoral researchers, experiment and analysis requests, and device supplies.
(Answer Health and Laborscience Rsearch grants, occupational injury clinical research operating expenses or Japan Agency for medical
Research and Dvelopment(AMED) in Q6.)

※As for contributions which research laboratory (in any fields or medeical department, etc.) receives, the head of the laboratory should report all of themunless a particular researcher is appointed to report.

１. YesFill out Table A

２. NoAnswer

Q６. Do you accept Health and Laborscience Rsearch grants, occupational injury clinical research operating expenses or Japan Agency for

medical Research and Dvelopment(AMED)?
If there is an acceptance(Including this year's plan), please fill out Table A Academia-Industry Collaborations regardless of the amount.
In addition, if you are a research participant who is not allocated research funds, please fill out Table A.

１. YesFill out Table A

２. NoAnswer

Academia-industry collaborations your husband/wife, parents,
or sons/daughters have been engaged in, or plan to do※Please choose number 1 or 2.

Q７. Are there any that your husband/wife, parents, or sons/daughters will be in relation, such as Q2 - Q4 above, to companies or organizations
our uuniversity are related to in academia-industry collaborations?

１. YesFill out Table B２. NoDoneAnswer※Please write the details about your answers in Q2 - Q7 into Table A below.
Please see the attachment "How to Fill out Tables."Table A Academia-industry collaborations you have been engaged in, or plan to do
Ⅱ Academia-IndustryCollaborations

Ⅰ Financial Interests（Details about Q２～４）
Companies/
Organizaitons
Name

Ⅰ-Ａ
Financialinterests

Ⅰ-Ｂ
Role
(Director,Adviser,etc.)

Ex○○○Pharma

3Ex○○○College

2Part-time
instructor

Ex○○○, Inc.

11Director

Ⅰ-Ｃ

Ⅰ-Ｄ
Hours of sidejob (total hoursAmountreceived/year) ※Fill in(Ten thousand
only if you haveyen/year)side job

Ⅰ-Ｅ

Ⅱ-Ａ

Number ofAcademiaequities
industry(Possessioncollaboration
Rate)
Shares230

130（Details about Q５～Q６）％

96

Shares
％10 Shares
1％(Ten thousandyen/year)

12023.4.1～
2025.3.31400

32023.2.1

250

22024.4.1～
2025.3.31

230○○○○Research〇〇

Research grant○○○○Research％
Shares％Shares4％
Shares5％
Shares

6％

Table B

Academia-industry collaborations your husband/wife, parents,
or sons/daughters have been engaged in, or plan to doⅡ Academia-Industry
Collaborations

Ⅰ Financial Interests（Details about Q７）
Companies/Organizaitons
Name

3

Amountreceived

Shares32

Period/Time

ⅢOther comments in particular％

2

1

Ⅱ-Ｃ

Shares1Ex

Ⅱ-Ｂ○○○Pharma

Ⅰ-Ａ

Ⅰ-Ｂ

Ⅰ-Ｃ

Financialinterests

Role(Director,Adviser,etc.)

Amountreceived(Ten thousandyen/year)2

Director

100

Ⅰ-Ｄ
Hours of sidejob (total hours/year) ※Fill in
only if you
have side job

Ⅰ-Ｅ

Ⅱ-Ａ

Number of
Academiaequities
industry(Possession
collaboration
rate)
Shares％Shares％Shares％Shares％

Ⅱ-Ｂ

Ⅱ-Ｃ

Period/Time

Amountreceived(Ten thousandyen/year)ⅢOther comments in particularwife

How to Fill out Tables
If you answer "1.Yes" in Q2-Q4, please fill out "ⅠFinancial Interests" in Table A.
If you answer "1.Yes" in Q7, please fill out "ⅠFinancial Interests" in Table B.
Companies/
Organizaitons
Name

Ⅰ-A

Please write name of companies or organizaitons which you are related to.
Please choose a content of academia-industory collaborations from 14 choices below, and write the number in ⅠA.(Estimated ones are also included.)Number1234567891011121314

ContentsSalaryRemuneration for side jobs (Excluding for medical care)※In case you have recieved more thanReward (for lectures, etc.)
1 million yen as personal income in a
Payment for manuscripts
year from the same
Payment for consultants
company/organizaiton.
（FY2023,FY2024)
License fee （Royalty, etc.）
Other donations
Being appointed director, etc. (You already got permission to be.)※Fill out the form regardlessof income.
Being appointed director, etc. (You have applied to get permission to be.)
（FY2023,FY2024)
Being appointed director, etc. (You are going to apply to get permission to be.)Ownership of unlisted shares (if you have 1 or more shares)
Ownership of listed shares (if you have 5% or more of outstanding shares)
Ownership of share warrant (unexercised)
Others (in case of recieving more than 1 million yen as personal income in a year
from the same company/organizaiton.)

Ⅰ-B

Please write your role in Ⅰ-B if you have been apponted an exective or a director, etc.

Ⅰ-C

Please write the amount of income in Ⅰ-C if you have recieved, or are going to recieve more than
1 million yen in a year from the same company/organizaion.

Ⅰ-Ｄ

Please write total time you have spent on side jobs in a year if you have them.

Ⅰ-Ｅ

Please write the amount and possession rate (the persentage in total outstanding shares) if you own equities.

Ⅲ

Please write details about academia-industry collaborations, the range of report, or other commentsin particular in Ⅲ if you have.

If you answer "1.Yes" in Q５～Q６, please fill out "ⅡAcademia-Industory Collaborations" in Table A.
Companies/Organizaitons
NameⅡ-A

Please write name of companies or organizaitons which you are related to.
Please choose a content of academia-industry collaborations from 13 choices below, and write the number inⅡ-A. (Estimated ones are also included.)NumberContents

123456789101112

Collaborative researchConsigned research※In case you received more than 2 million yen
Contribution
from the same company/organizaion.
Research grantPrivate donation maintained course（FY2023,FY2024)
Commission of committee member, etc
License or transfer of intellectual property rights
Technical training
Acceptance of visiting researchers andRequest of experiment and analysis
Device supply
Others (in case you received more than 2 million yen in a year from the same company/organizaion.)

13

Health and Laborscience Rsearch grants, occupational injury clinical research operating expenses or Japan
Agency for nedical Research and Dvelopment(AMED)Ⅱ-B

In Ⅱ-B, please write the time and period of working or contract you chose in Ⅱ-A.

Ⅱ-C

Please write the amount in Ⅱ-C. ※It is fine to write it as far as you know or estimate it in coverd period.

Ⅲ

Please write details about academia-industry collaborations, the range of report, or other commentsin particular in Ⅲ if you have.

（Entry Example）

FY 2024 Self-Report on Conflict of Interest
Period covered

April 1, 2021 - March 31, 2023 (Including anticipated future financial interest / activities)※Please make sure to subumit answering Q1 and Q7 even if you are not relevant to conflict of interest.
To the Chairperson of Conflict of Interest Committee, University of the Ryukyus
I here by report the conflict of interest related to academia-industry collaborations based on article 22, Conflict of Intereset Management Provision.
Date2024Year

Affiliation(Faculty)MonthJuneDay10(Department)
Professor

Job title

RYUKYU TaroName

Please answer the following questions about academia-industry collaborations in which you or your husband/wife, parents, and sons/daughters have been
engaged, or plan to do. The collaborations are provided for in Article 3, Self-Report Implementation Guidelines about Conflict of Interest in University of theRyukyus.

Academia-industry collaborations you have been engaged in, or plan to do※Please choose number 1 or 2

Q１. Have you been engaged in any academia-industry collaborations in FY2023 and FY2024, or do you have any plans of them in FY 2024?
１．Yes

Please answer Q2 - Q7

２. No

Please answer Q7Answer

1

Academia-industry collaborations include side jobs (part-time instructor included), lectures, writing manuscripts, consultants, being
executives, possession of equities, collaborative researches, consigned researches, contributions, research grants, Health andLaborscience Rsearch grants, occupational injury clinical research operating expenses, Japan Agency for nedical Research andDvelopment(AMED),private donation maintained courses, licenses or transfers of intellectual property rights, acceptances of visiting※Please choose "2. No" if you have received/are going to receive only
researchers and postdoctoral researchers, and device supplies.
medical treatment fees.

Q２. Do you earn over 1 million yen in a year from the same company or organization by income, side jobs (part-time instructor included), lectures,
writing manuscripts, consultants, or royalties? (Excluding medical treatment fees)※Companies and organizations include private companies, general incorporated association, julidical foundation, nation, local public organizaions, independentadministrative institutions, medical corporations, educational foundations, incorporated nonprofit organizations (NPO) and national research and development
agency.

１. YesFill out TableA

２. No

Answer

1

Q３. Are you involved with management (being an executive, an advisor or a consultant) of any companies or organizations which are related toacademia-industry collaborations?

１. YesFill out Table A

２. No

Answer1

Answer

1

Q４. Do you own any equities※ of the other parties in academia-industry collaborations?
※Equity means listed/unlisted shares, funds, stock options, and beneficial interests.
※In terms of listed shares, answer "1. Yes" if you own more than 5% of outstanding shares from the same organization.

１. YesFill out Table A

２. No

Q５. Have you received more than 2 million yen altogether in a year(Including this year's plan) from the same company or organizaiton in academiaindustry collaborations? The collaborations include cooperative researches, contract researches, contributions, research grants, private

donation maintained courses, commissioner, licenses or transfers of intellectual property rights, technical training, acceptances of visiting
researchers and postdoctoral researchers, experiment and analysis requests, and device supplies.
(Answer Health and Laborscience Rsearch grants, occupational injury clinical research operating expenses or Japan Agency for medical
Research and Dvelopment(AMED) in Q6.)
※As for contributions which research laboratory (in any fields or medeical department, etc.) receives, the head of the laboratory should report all of them unlessa particular researcher is appointed to report.

１. YesFill out Table A

２. NoAnswer1

Q６. Do you accept Health and Laborscience Rsearch grants, occupational injury clinical research operating expenses or Japan Agency for medicalResearch and Dvelopment(AMED)?
If there is an acceptance(Including this year's plan), please fill out Table A Academia-Industry Collaborations regardless of the amount.
In addition, if you are a research participant who is not allocated research funds, please fill out Table A.

１. YesFill out Table A

２. NoAnswer

Academia-industry collaborations your husband/wife, parents,
or sons/daughters have been engaged in, or plan to do1※Please choose number 1 or 2.

Q７. Are there any that your husband/wife, parents, or sons/daughters will be in relation, such as Q2 - Q4 above, to companies or organizations ouruuniversity are related to in academia-industry collaborations?

１. YesFill out Table B

２. NoDoneAnswer

2※Please write the details about your answers in Q2 - Q7 into Table A below.
Please see the attachment "How to Fill out Tables."Table A Academia-industry collaborations you have been engaged in, or plan to do
Ⅱ Academia-Industry
Collaborations

Ⅰ Financial Interests（Details about Q２～４）
Companies/
Organizaitons
Name

Ⅰ-Ａ

Ⅰ-Ｂ

Financialinterests

Role(Director,Adviser,etc.)

Ⅰ-Ｃ（Details about Q５～Q６）

Ⅰ-ＤⅠ-Ｅ

Hours of side
Amountjob (total hoursreceived/year) ※Fill in(Ten thousand
only if you haveyen/year)side job

Ⅱ-Ａ

Number ofAcademiaequitiesindustry(PossessioncollaborationRate)
SharesEx○○○Pharma

3Ex○○○College

2Part-time
instructor

Ex○○○, Inc.

11Director

Ex

AMED

1△△
Foundation

2○×, Inc.

Shares3〃

Shares4○○○
Institute, Inc.

115〇〇academic
conference8

6

Health andLaborscience
Rsearch grant

Shares7

Health andLaborscience
Rsearch grant

Shares

8AMED

Table B

Academia-industry collaborations your husband/wife, parents,or sons/daughters have been engaged in, or plan to do

230％

130

Shares

96％
10 Shares
1％
Shares％

3120

90Ex

12

3

○○○Pharma

ⅢOther comments in particular

Amountreceived(Ten thousandyen/year)

12023.4.1～
2025.3.31

400○○○○Research

32023.2.1

250〇〇 Research grant2

2024.4.1～
2025.3.31

230○○○○Research

132024.4.1～2025.3.31

230○○○○Research

Reward for lectures (15 times/year)

％

％

％

1

2021.4.1～
2022.3.31

260

Developing system by ○○32021.4.1～
2022.3.31

200

Contribution for △△△ course

132021.4.1～
2022.3.31

100○○○Research132022.4.1～
2023.3.31

0

○○○研究

13

2021.4.1～
2022.3.31

20〇〇project

25
Shares3 ％Director012

Shares％％％Shares％

Ⅰ-Ａ

Period/Time

Ⅱ-Ｃ

SharesⅡ Academia-Industry
Collaborations

Ⅰ Financial Interests（Details about Q７）
Companies/
Organizaitons
Name

Ⅱ-Ｂ

Ⅰ-Ｂ

Ⅰ- Ｃ

Financialinterests

Role(Director,Adviser,etc.)

Amountreceived(Ten thousandyen/year)2

Director

100

Ⅰ-Ｄ
Hours of sidejob (total hours/year) ※Fill in
only if you
have side job

Ⅰ- Ｅ

Ⅱ-Ａ

Number ofAcademiaequities
industry(Possessioncollaborationrate)
Shares％Shares％
Shares％Shares％

Ⅱ-Ｂ

Ⅱ-Ｃ

Period/Time

Amountreceived(Ten thousandyen/year)

ⅢOther comments in particular

wife