奨学寄附金申込書（奨学寄附金用（研究助成金除く））

Donation Form (For education and research, excluding research grants)

Date:

(Month DD, YYYY)

To: The President, National University Corporation Tokyo Institute of Technology

DonorAddress:

Donor’s name:

Donor’s representative:

(Position and name) Official seal

I wish to make the following contribution as a donation for education and research.

Donation amount / yen
Purpose of donation / To contribute to education and research and to support academic activities of students
Conditions of donation / None
Name of donation / None
Name, affiliation, and position of designated project coordinator (e.g., faculty member) or name of designated organization coordinating the project
Name, address, telephone number, and other details, such as company name, affiliation, and position, if applicable, of the person in charge of the donor's administration work
Note: Please provide the address where a Payment Request Form from Tokyo Institute of Technology should be sent.
Your expected date of payment
Note: If you wish to pay in installments, please contact the designated administration group below. / The last day of (Month, YYYY)
Notes
  1. Please submit this form by the 20th of the month preceding the month of your expected date of payment.
  2. We will send a Payment Request Form to the person in charge of administration work on or around the 10th of the month of your expected date of payment. If you need the Payment Request Form earlier, please indicate this in the Notes box or consult the designated administration group below.
  3. We will send the receipt by the end of the month following the month of payment. If you need the receipt earlier, please indicate this in the Notes box or consult the designated administration group below.
  4. Even if the donation is called a research grant, if there are no application and review processes involved, please use this form.

  • This donation qualifies either as a specific donation for which a donation deduction can be made under the Income Tax Act or as being fully tax deductible under the Corporation Tax Act, as designated by the finance minister.
  • Upon request for disclosure of information under the information disclosure system, information provided by the donor on the Donation Form, excluding personal information, may be disclosed.
  • We are unable to accept a contribution as a donation for education and research if it includes the following.
-A condition requiring patent rights and/or other equivalent rights arising from research done using the donation to belong to the donor
-A condition requiring the parties concerned to sign a contract or a condition requiring the parties concerned to be recompensed the equivalent value of any achievements

Inquiries Donations for education and research (excluding research grants)

Planning and Management Group, Industrial Cooperation Division, Research Promotion Department
Tokyo Institute of Technology
E3-11, 2-12-1, Ookayama, Meguro-ku, Tokyo 152-8550
Tel: 03-5734-3817, Fax: 03-5734-2482Email:

Research grants

Research Promotion Group, Research Planning Division, Research Promotion Department
Tokyo Institute of Technology
E3-10, 2-12-1, Ookayama, Meguro-ku, Tokyo 152-8550
Tel: 03-5734-3806, Fax: 03-5734-3683Email:

PJ code / SH/KJ / Existing / New□ Emailed
Payee’s number / SH/KJ / Outside employment / Yes / No
Resolution number / Funds in common / Yes
No (Research grant, Industry-Sponsored Program, aid for study, other)

*For office use

201609

奨学寄附金申込書（奨学寄附金用（研究助成金除く））

Donation Form (For education and research, excluding research grants)

Points to note

Date:

(Month DD, YYYY)

To: The President, National University Corporation Tokyo Institute of Technology

DonorAddress:

Donor’s name:

Donor’s representative:

(Position and name) Official seal

Personal seal alone is not acceptable.

I wish to make the following contribution as a donation for education and research.

Donation amount / yen
Purpose of donation / To contribute to education and research and to support academic activities of students
Conditions of donation / None (We are unable to accept a contribution with any of the conditions in the box below attached.)
Name of donation / None
Name, affiliation, and position of designated project coordinator (e.g., faculty member) or name of designated organization coordinating the project
Name, address, telephone number, and other details, such as company name, affiliation, and position, if applicable, of the person in charge of the donor's administration work
Note: Please provide the address where a Payment Request Form from Tokyo Institute of Technology should be sent.
Your expected date of payment
Note: If you wish to pay in installments, please contact the designated administration group below. / The last day of (Month, YYYY)
Notes
  1. Please submit this form by the 20th of the month preceding the month of your expected date of payment.
  2. We will send a Payment Request Form to the person in charge of administration work on or around the 10th of the month of your expected date of payment. If you need the Payment Request Form earlier, please indicate this in the Notes box or consult the designated administration group below.
  3. We will send the receipt by the end of the month following the month of payment. If you need the receipt earlier, please indicate this in the Notes box or consult the designated administration group below.
  4. Even if the donation is called a research grant, if there are no application and review processes involved, please use this form.

  • This donation qualifies either as a specific donation for which a donation deduction can be made under the Income Tax Act or as being fully tax deductible under the Corporation Tax Act, as designated by the finance minister.
  • Upon request for disclosure of information under the information disclosure system, information provided by the donor on the Donation Form, excluding personal information, may be disclosed.
  • We are unable to accept a contribution as a donation for education and research if it includes the following.
-A condition requiring patent rights and/or other equivalent rights arising from research done using the donation to belong to the donor
-A condition requiring the parties concerned to sign a contract or a condition requiring the parties concerned to be recompensed the equivalent value of any achievements

Inquiries Donations for education and research (excluding research grants)

Planning and Management Group, Industrial Cooperation Division, Research Promotion Department
Tokyo Institute of Technology
E3-11, 2-12-1, Ookayama, Meguro-ku, Tokyo 152-8550
Tel: 03-5734-3817, Fax: 03-5734-2482Email:

Research grants

Research Promotion Group, Research Planning Division, Research Promotion Department
Tokyo Institute of Technology
E3-10, 2-12-1, Ookayama, Meguro-ku, Tokyo 152-8550
Tel: 03-5734-3806, Fax: 03-5734-3683Email:

PJ code / SH/KJ / Existing / New□ Emailed
Payee’s number / SH/KJ / Outside employment / Yes / No
Resolution number / Funds in common / Yes
No (Research grant, Industry-Sponsored Program, aid for study, other)

*For office use

201609