Date: (Day), (Month), (Year) s1

Form 1 (for Articles No. 4 & No. 6) Date: (day), (month), (year)

Mr. Hideo Yamada, President, Yamada Bee Company, Inc.

(Address)

(Tel. / Fax) (E-mail) (Institutional Affiliate) (Title) (Print Name) (Signature)

Grant Application Form for “Yamada Research Grant 2014”

I apply for the provisioning of the grant mentioned above in the title by following Article No. 6 in the “Yamada Research Grant 2014” Outline for Grant Provision as follows. I will implement a research for the following research theme based on the separately submitted research plan document, and will make a report of the research outcomes by the due date specified by the Yamada Bee Company, Inc.

Description

1 The theme of the grant research (English)

2 The overview and the purpose of the grant research (explain in an easy to understand description, in approx. 240 characters) 3 The amount applied for the grant: Yen (Japanese yen)

4 The concrete contents, etc. of the grant research, and the allocation of expenses required for the grant research As specified in (Exhibit) Grant research Plan Document for “Yamada Research Grant 2014”.

5 Research period: year(s)

6 The research period scheduled end date: September 30, 20 . (Exhibit of Form 1) Grant research Plan Document for “Yamada Research Grant 2014”

1 Contents of the research, etc. Ⅰ. Outline of the research ・Outline of the research and the targeted outcome

Outline:

Impact of the outcome:

2 Research Plan Research Design Necessary ※ Please fill out this column with the Equipments and necessary information below. Materials ※ ・object Please fill out this Expenses column with the Amount ・sample size category necessary information (Yen) (number※) ・the extent of exposure as described in (methods of administration, dose, dosage Appendix of the schedule) Outline for Grant ・end point Pronsion. (period)

(year/month)

Total Yen (Japanese yen) ※ As for the expenses category number, please refer to Appendix of “Yamada Research Grant 2014” Outline for Grant Provision (There is not a limit on number of pages. Please add lines as necessary.)

Ⅱ．Joint research partners (Fill in the following columns when you plan to implement joint researches. If there are several partners, make sure to describe all of them.) Institutional Affiliate

Co-researchers

〒 - Address

Contents of allocated researches, etc. Equipments / facilities / building possessed by the partner

Ⅲ．Consignee / Subcontractor (Fill in the following columns when you plan to consign / outsource a part of your research. If there are several consignees / subcontractors, make sure to describe all of them.) Institutional Affiliate

〒 - Address

Contents of consignment / outsourced works, etc. Equipments / facilities / building possessed by the consignee / subcontractor

Ⅳ． Technical guidance or cooperation to be gained from other parties (Fill in the following columns when you plan to have technical guidance or cooperation provided.) Institutional Affiliate Name of instructor / cooperating person Title The matter for which the guidance or cooperation will be provided

Ⅴ．Samples to be provided (Fill out the columns with amount required and reasons about the sample(s) required for your research. See 'Research samples of honeybee products and natural products' page on our website for more details on each sample.) URL(http://www.bee-lab.jp/grant/grant/grant_2014/sample.html) ・Samples for clinical trials Reasons (administration Amount route, amount of intake, Samples required research period, number of subjects, etc.) Enzyme-treated royal jelly [100 coat tablets / bottle] bottle Placebo (for Enzyme-treated royal jelly) [100 coat tablets / bottle bottle] Brazilian propolis [100 softgel capsules / bottle] bottle

Placebo (for Brazilian propolis) [100 softgel capsules / bottle] bottle

Enzyme-treated bee larvae [100 softgel capsules / bottle] bottle Placebo (for Enzyme-treated bee larvae) [100 softgel capsules bottle / bottle] Acacia honey [300 g / bottle] bottle

Bee pollen (no placebo) [120 plain tablets / bottle] bottle

Melinjo resveratrol [62 capsules / pouch] pouch

Placebo for melinjo resveratrol [62 capsules / pouch] pouch

Glucosamine [120 capsules/pouch] pouch

Collagen [300 plain tablets/ pouch] pouch

Bilberry [60 capsules/ pouch] pouch

DHA/EPA [150 softgel copsules/ pouch] pouch

Sesamin [60 plain tablets/ pouch] pouch

Chlorella [300 plain tablets/pouch] pouch Lutein, Coenzyme, Hyaluronic acid, Ginkgo biloba extract, Chondroitin, Saw palmetto, Maca, Octacosanol, etc. [capsules] ※ Please type sample's name, amount and the reason for research samples you want in the "Reasons (administration route, amount of intake, research period, number of subjects, etc.)" column.

・Samples for animal and/or in vitro test Reasons (administration Amount route, research period, Samples State required number of groups, number of subjects, etc.) Royal jelly powder (enzyme-treated) powder g Royal jelly powder (enzyme-untreated) powder g Ethanol extract of Brazilian propolis liquid g Ethanol extract powder of Brazilian propolis powder g Bee larvae powder (enzyme-treated) powder g Acacia honey liquid g

Bee pollen powder g

Extract powder of Melinjo seed powder g

Glucosamine powder powder g

Collagen powder powder g

Bilberry powder powder g DHA/EPA oil powder g

Sesamin powder powder g

Chlorella powder powder g Lutein oil, Coenzyme powder, Hyaluronic acid powder, Ginkgo biloba extract powder, Saw palmetto oil, Chondroitin powder, Maca powder, Octacosanol, etc. See the ※Please type sample's name, amount and the left reason for research samples you want in the culumn "Reasons (administration route, research period, number of groups, number of subjects, etc.)" column.

Form 2 (for Article No. 6)

Promissory Letter

I pledge that as for receiving the “Yamada Research Grant 2014”, that I consent to the contents specified in the “Yamada Research Grant 2014” Outline for Grant Provision and that I will implement the following grant research.

Description

＜Contents of the grant research＞ The theme of the grant research Grant amount Yen (Japanese yen) Outline and purpose of the grant research Grant period October 1, 2014 – September 30, 20 As described in Grant Application Form for “Yamada Research Research Grant 2014” (Form 1) and “Research Plan method Document” (Exhibit of Form 1). Name of co-researchers

Date: (day), (month), (year)

(Address)

(Tel. / Fax) (Institutional Affiliate) (Title) (Print Name) (Signature)

Form 3 (for Articles No. 6) Date: (day), (month), (year) Mr. Hideo Yamada, President, Yamada Bee Company, Inc.

(Address)

Bank Transfer Account Notice for “Yamada Research Grant 2014”

I notify hereafter the account for the “Yamada Research Grant 2014”.

Bank transfer account (Account with Institution) Bank and Branch Name Branch Address SWIFT Code. FED ABA. SORT Code. BLZ No. Country

Account number Beneficiary Customer

Beneficiary Address (Country: )

Contact information for the person in charge or account (Institutional Affiliate) businesses (Name) (Title) (Please fill in this column only when the person in charge of the （Tel.）（Fax） accounting works is different from the applicant.) （Mail） Credit

Yen (Japanese yen)

Form 4 (for Articles No. 11) Date: (day), (month), (year)

Mr. Hideo Yamada, President, Yamada Bee Company, Inc. (Address)

Application Form for Changes for the Grant Research (Contents / Expenses Allocation) for “Yamada Research Grant 2014”

I apply for the approval for the changes for the grant research mentioned in the title (contents / expenses allocation) whose grant provisioning notice had been issued as No. as of (date) (month) (year) as described below, by following the provision specified in Paragraph 1 of Article No. 11 of the “Yamada Research Grant 2014” Outline for Grant Provision.

Description

1 Reason for the change

2 Description of the change

3 Impact assumed from the change (Exhibit of Form 4) Date: (day), (month), (year)

(Address)

Representative (Organization, Address, Title) Change Notice

I notice the change or representative (organization, address) as follows.

Description

1 Reason for change

2 Changed matter

3 Changed to; Form 5 (for Articles No. 13) Date: (day), (month), (year)

(Address)

Grant Research Cancellation (Discontinuation) Approval Application Form for “Yamada Research Grant 2014”

I apply for the approval for the cancellation (discontinuation) for the grant research mentioned in the title whose grant provisioning notice had been issued as No. as of (date) (month) (year) as described below due to the following reason, by following the provision specified in Article No. 13 of the “Yamada Research Grant 2014” Outline for Grant Provision.

Description

1 Research theme

2 Reason for the cancellation (discontinuation)

3 Cancellation (discontinuation) period

Note) Make sure to attach explanatory documents. Form 6 (for Articles No. 14) Date: (day), (month), (year)

(Address)

Report on Delay of the Grant Research, etc. for “Yamada Research Grant 2014”

I report the following accident for the grant research mentioned in the title whose grant provisioning notice had been issued as No. as of (date) (month) (year), by following the provision specified in section Article No. 14 of the “Yamada Research Grant 2014” Outline for Grant Provision.

Description

1 Progress status of the grant research

2 The description and cause of the accident

3 Measures taken for the accident

4 Schedule for implementing / completing the grant research

Note) Make sure to attach documents proving the cause of the accident (in any format). Form 7 (for Articles No. 13 & No.16) Date: (day), (month), (year)

(Address)

Final Report for “Yamada Research Grant 2014”

I have completed (cancelled) the grant research mentioned in the title whose grant provisioning notice had been issued as No. as of (date) (month) (year) on (date) (month) (year), and therefore report its outcome hereafter by following the provision specified in Articles No. 13 & No. 16 of the “Yamada Research Grant 2014” Outline for Grant Provision.

Description

1 Research theme (English)

2 The amount received for the grant Yen (Japanese yen)

3 Outcome of the grant research 1 Summary (in English within approx. 240 characters) ※ The summary will be posted on the website of Institute of Bee Products and Health Science without making any correction.

2 Details As described in (Exhibit) Grant research Result Report for the “Yamada Research Grant 2014” and in the dissertation for the grant research. Note) If there is any reference material for the outcome of the grant research (photographs, result document, etc.), make sure to attach it. (Exhibit of Form 7) Grant research Result Report for “Yamada Research Grant 2014”

Joint research

(1) Name of organization (2) Division of roles (3) Contract day

Consigned research

(1) Consignee/address (2) Contents of the research

Guidance, etc. gained from other organizations

(1) Name of organization (2) Name of the person (3) Title (4) Contents of the guidance, etc. Form 8 (for Articles No. 13, No. 15, No. 16 & No. 21) Date: (day), (month), (year)

(Address)

Payment Details for “Yamada Research Grant 2014”

Paid on Expenses Sales No. (date / month / Name or description Price Total category tax year) (number)

※As for the expenses category number, please refer to Appendix 1 of the “Yamada Research Grant 2014” Outline for Grant Provision and make sure to list the items in the order corresponding to date of payment. Form 9 (for Articles No. 15 & No. 16) Date: (day), (month), (year)

(Address)

Interim Report for “Yamada Research Grant 2014”

( year/ years) Eg. (1st year/3 years)

I report hereafter for the grant research mentioned in the title whose grant provisioning notice had been issued as No. as of (date) (month) (year) as described below by following the provision specified in Article No. 15 & No. 16 of the “Yamada Research Grant 2014” Outline for Grant Provision.

Description

The status of the grant research;

The future plans of the grant research;