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Emergency medical notification system related

Updated: April 2nd, 2021

PDF format

It is in PDF file format, so please print it out and use it.
Note : We recommend using plain paper for printing and A4 or B5 print size.
Thermal paper for thermal printers will not be accepted.

File Download Opens in a new window.Form No. 1 Notification of Appointment of Agent (PDF: 92KB)

File Download Opens in a new window.Emergency medical notification form (PDF: 102KB)

Word/Excel format

It is in Word and Excel file format, so please print it out and use it.
Note : We recommend plain paper and print sizes of A4 and B5.
Thermal paper for thermal printers cannot be accepted.

File Download Opens in a new window.Form No. 1 Notification of Appointment of Agent (Word: 16KB)

File Download Opens in a new window.Emergency Medical Notification Form (Excel: 59KB)

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

Inquiries regarding this page

Inagi City Fire Department Headquarters Police Department
2111 Higashinagumanuma, Inagi City, Tokyo (Inagi Fire Station)
Phone: 042-377-7119 Fax: 042-377-0119

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Inagi City's official mascot, Inagi Nashinosuke

Inagi City Hall

2111 Higashinagumanuma, Inagi City, Tokyo 206-8601
Office hours: 8:30 a.m. to 5:00 p.m. Main phone: 042-378-2111 Fax: 042-377-4781
Copyright (C) Inagi City. All rights reserved.
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