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Guidelines for Certification of Compliance with
Industrial Safety and Health Law GLP concerning Test Facilities, etc.
In Japanese

Form 4

Notification of Discontinuation of Test Facilities

Date

For the attention of
Director-General of Labour Standards Bureau of
Ministry of Health, Labour, and Welfare

Name
Address		Seal

I would like to notify as follows pursuant to the provisions of No. 5 of Guidelines for Certification of Compliance with Industrial Safety and Health Law GLP concerning Test Facilities, etc.

Note

	1		Name and location of the test facilities, etc.
	2		Date and Ref. No. of the latest certification of compliance
	3		Contents of discontinuation
	4		Reasons for discontinuation
	5		Time of discontinuation

	Note 1		The paper size shall be JIS A4 paper size.
	Note 2		Enter the location of the principal office in the column of address in the case of corporation.
	Note 3		Enter the company name and the name of the representative in the column of the name in the case of corporation.

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