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Transportation business related to patients, etc.

Updated: April 1, 2021

PDF format

It is in PDF file format, so please print it out and use it.
Note : Plain paper is recommended for print paper, and A4 or B5 print sizes are recommended.
Thermal paper for thermal printers cannot be accepted.

File Download Opens in a new window.Separate form No. 3 Disinfection implementation record table (PDF: 30KB)

File Download Opens in a new window.Appended Form No. 4 Singular Case Report (PDF: 49KB)

File Download Opens in a new window.Separate form No. 5 Application for transport crew for patients (PDF: 65KB)

File Download Opens in a new window.Appended form No. 6 special qualified person application (PDF: 56KB)

File Download Opens in a new window.Appended Form No. 7 Patient Transportation Business Authorization (Renewal) Application Form (PDF: 53KB)

File Download Opens in a new window.Appended form No. 9 Notification of vehicle for transportation of patients (PDF: 50KB)

File Download Opens in a new window.Appended form No. 9-2 Notification of vehicle for patient transport (vehicle photo) (PDF: 48KB)

File Download Opens in a new window.Appended Form No. 10 Certificate of Eligibility Reissuance Application (PDF: 62KB)

File Download Opens in a new window.Appended Form No. 11 Patient transportation company/Automobile certification mark reissuance application form (PDF: 46KB)

File Download Opens in a new window.Appended Form No. 12 Business content change notification (PDF: 42KB)

File Download Opens in a new window.Appended Form No. 19 Certification Mark Receipt (PDF: 54KB)

Word/Excel format

It is in word and excel file format, so please print it out and use it.
Note : Plain paper is recommended for print paper, and A4 or B5 print sizes are recommended.
Thermal paper for thermal printers cannot be accepted.

File Download Opens in a new window.Separate form No. 3 Disinfection implementation record table (Excel: 11KB)

File Download Opens in a new window.Appended Form No. 4 Singular Case Report (Excel: 15KB)

File Download Opens in a new window.Appended Form No. 5 Application for Transportation Crew Attendance for Patients (Excel: 15KB)

File Download Opens in a new window.Separate Form No. 6 Application for Exceptionally Appointed Person (Excel: 14KB)

File Download Opens in a new window.Appended form No. 7 patient transportation business authorization (renewal) application form (Excel: 19KB)

File Download Opens in a new window.Appended Form No. 9 Notification of Vehicle for Transportation of Patients, etc. (Excel: 12KB)

File Download Opens in a new window.Appended Form No. 9-2 Notification of Vehicle for Transportation of Patients (vehicle photo) (Excel: 10KB)

File Download Opens in a new window.Appended Form No. 10 Application for Reissuance of Certificate of Eligibility (Excel: 15KB)

File Download Opens in a new window.Appended Form No. 11 Application for Reissuance of Vehicle Accreditation Mark for Transportation of Patients etc. (Excel: 18KB)

File Download Opens in a new window.Appended Form No. 12 Notification of change in business content (Excel: 18KB)

File Download Opens in a new window.Appended Form No. 19 Certification Mark Receipt (Excel: 20KB)

Adobe Acrobat Reader DC (formerly Adobe Reader) is required to open PDF format files.
If you don't have it, you can download it for free from Adobe.
Get Adobe Acrobat Reader DCDownload Adobe Acrobat Reader DC

Inquiries about this page

Inagi City Fire Department Headquarters Security Division
2111 Higashi Naganuma, Inagi City, Tokyo (Inagi Fire Station)
Phone: 042-377-7119 Fax: 042-377-0119

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Inagi City Hall

2111 Higashi Naganuma, Inagi City, Tokyo 206-8601
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