RIKEN Borrowing and Reproduction Request Form
Date:

ApplicantCompany name:Name of person in charge (applicant):
Address:
Tel.:
Fax:

Section/Division:(Country:) Postcode:
E-mail:What material(s) do you want to reproduce or borrow?
Description of the materials:
Types of materials (circle the appropriate item(s))(1) Printed material(2) Photograph (negative, positive, or picture file)(3) Part of the RIKEN website(4) Display item(5) Microfilm(6) Others: __________________________
Website URL:
Purpose of use---Why would you like to have above these?
Title of document:
Purpose of use:
Period of use:
Way to use---How would you like to use them? Multiple answers allowed(1) Reprint all / part of article, magazine, and/or website(2) Borrow all / part of the materials(3) Copy all / part of the materials to distribute ( ____ ) # of copy volume(4) Others:
Conditions of use
Applicants (persons requesting permission to reproduce materials) must follow the rules below.
1. Take care not to damage or lose the materials.
2. If rights to the materials belong to a third party, get permission to use them from the third party.
3. Use the materials only for the purpose described above, and do not lend or give the materials toany third party.
4. Use the materials only once, not repeatedly or continuously.
5. Specify clearly that the materials are provided by RIKEN, or specify the source clearly.
6. Provide to RIKEN one copy of the newspaper, magazine, book, or video recording of the TV
program, or one copy of the part where the materials are used and the part where RIKEN iscredited.
7. Do not trim photographs or write captions or explanatory text for them in such a way as toconvey a different meaning from the original photograph.
8. Return borrowed materials by the date on which they are due to be returned, or as soon as thework is finished. (Due date:.)9. Explain the contents of the publication in which the materials are used, if requested by RIKEN.
10. RIKEN takes no responsibility for any damage or loss that may result from the reproduction or
borrowing of its materials, to the party that uses the materials or to any third party.
11. The reproduction or borrowing of the materials must cause no damage or loss to RIKEN.
12. Issues not specified in this list shall be specified elsewhere.
13. Other:------------------------------------------------------------------------------------------------------------------------Date:To:
You are permitted to borrow and reproduce the materials as described above.

SPring-8 Center Promotion Office, RIKEN
1-1-1 Kouto, Sayo-cho, Sayo-gun, Hyogo 679-5148, Japane-mail：harima-suishin@riken.jp

RIKEN Borrowing and Reproduction Request Form
ExampleDate: 2020/1/6
ApplicantCompany name:
Hill Pharmaceuticals
Section/Division:
Publications Office
Name of person in charge (applicant):
Boris Korey
Address: Hill Building, 33 Xxxx Street, Xxxxx City, Xxxxx (Country: Canada) Postcode: XXX
Tel.: 00-0000-0000
Fax: 00-0000-0000
E-mail: xxxxx@xxxxxx.co.jp

What material(s) do you want to reproduce or borrow?
Description of the materials:
photograph of Dr. Xxxxxxx (high-quality image)Types of materials (circle the appropriate item(s))(1) Printed material(2) Photograph (negative, positive, or picture file)
Please write URL of(3) Part of the RIKEN website
the material you(4) Display item(5) Microfilm(6) Others: __________________________
want to reproduce.
Website URL:
http://www.riken.jp/~xxxx/nishina.jpg
Purpose of use---Why would you like to have above these?
Title of document: A book we are publishing called Fifty Years of Hill Pharmaceuticals
Purpose of use: Include photo of Dr. Xxxxxxx and describe his great contributions to our research
Period of use: Publication is scheduled for January 20XX (see attached sheets for details)
Attach extra
sheets if
Way to use---How would you like to use them? Multiple answers allowednecessary.
(1) Reprint all / part of article, magazine, and/or website(2) Borrow all / part of the materials
If you want to use the(3) Copy all / part of the materials to distribute ( ____ ) # of copy volume(4) Others:
modified material,
please write how will
Conditions of use
you edit that.
Applicants (persons requesting permission to reproduce materials) must follow the rules below.
1. Take care not to damage or lose the materials.
2. If rights to the materials belong to a third party, get permission to use them from the third party.
3. Use the materials only for the purpose described above, and do not lend or give the materials toany third party.
4. Use the materials only once, not repeatedly or continuously.
5. Specify clearly that the materials are provided by RIKEN, or specify the source clearly.
6. Provide to RIKEN one copy of the newspaper, magazine, book, or video recording of the TV
program, or one copy of the part where the materials are used and the part where RIKEN iscredited.
7. Do not trim photographs or write captions or explanatory text for them in such a way as toconvey a different meaning from the original photograph.
8. Return borrowed materials by the date on which they are due to be returned, or as soon as thework is finished. (Due date:.)9. Explain the contents of the publication in which the materials are used, if requested by RIKEN.
10. RIKEN takes no responsibility for any damage or loss that may result from the reproduction or
borrowing of its materials, to the party that uses the materials or to any third party.
11. The reproduction or borrowing of the materials must cause no damage or loss to RIKEN.
12. Issues not specified in this list shall be specified elsewhere.
13. Other:------------------------------------------------------------------------------------------------------------------------Date: 2020 / 1 / 6
To:
Boris Korey
You are permitted to borrow and reproduce the materials as described above.

SPring-8 Center Promotion Office, RIKEN
1-1-1 Kouto, Sayo-cho, Sayo-gun, Hyogo 679-5148, Japane-mail：harima-suishin@riken.jp

This part will befilled in by RIKEN,
and the form willthen be returned toyou.