[See Rule 24(1)]

FORM 15 FORM FOR APPLICATION FOR RENEWAL OF REGISTRATION OF HOSPITAL FOR TRANSPLANTATION OF HUMAN ORGANS (See Rule 24(1))

1. Name of hospital:

1. 2. 3. 4. 5. 6.

7.

(A)

1. 2. 3. 4. 5. 6. 7.

(B)

1. 2. 3. 4.

(C)

1. 2. 3. 4.

(D)

1. 2. 3. 4.

(E)

1. 2. 3. 4.

(F)

1. 2. 3. 4.

(G)

1. 2. 3. 4.

(H)

1. 2. 3. 4.

(I) (Hospital/Medical Registration (In the hospital or the name))