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<CEO Network Enhancing Project (CEONEP)>　Application Form　
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Web-Based CEO Business Meeting Event for Medical Equipment
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<Application Form>
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Thank you for your interest in CEO Business Meeting hosted by SME SUPPORT JAPAN.
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The main purpose of the CEO Business Meeting Event is mutually increasing corporate values through partnerships in technical cooperation and co-development among many more possibilities.
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All applicants will be carefully screened and selected by SME SUPPORT JAPAN. The screening process highly prioritizes your goals, motivation and the level of matching probability with Japanese companies.
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This application consists of the following questions:
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1.General information of your company
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2.Information on Joining this Business Meeting Event
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3.Business outline
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4.Previous experience in international business
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5. Post Pictures
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Please answer as many questions as you can for us to fully understand your company and business detail.
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※Please kindly note that your requests for any specific business meeting are NOT guaranteed.
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1．General information of your company
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Provide general information about your company. Please enter your information in English.
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Name of Industrial Associations Your Company Belong to （Required）
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Company Name （Required）
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Country/Economy （Required）
City
（Required）
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Complete Address (Street, City, State/Province, Country, Postal Code) （Required）Name of Company Representative (Prefix - Mr., Ms., Mrs., etc. ) （Required）
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Participant Name (Prefix)
（Required）		Participant Department/Division （Required）
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Participant Title （Required）Participant Email Address
（Required）
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Participant Mobile Phone Number
（Required）		Participant Office Phone Number （Required）
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What is the participant(s)' overall English proficiency level?（Required）Please Select
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Contact Person Name (Prefix)
Contact Person Department/Division
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Contact Person TitleContact Person Email Address
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Contact Person Mobile Phone Number
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Number of Employees in Your Company
(Required)		PersonsYear of Establishment
(Required)		Sample) 2002
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Do you have a department that sells products to your group companies or other companies?　　(Required)Please SelectIf "Yes", please indicate how many companies you sell your products to in the box on the right.Companies
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If any offices other than Headquarters, please indicate the addresssample) Hong Kong, BangKok
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Latest Annual Sales
(US Dollars) (Required)		Paid-in Capital (US Dollars) (Required)
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Website URL (Required)sample) https://www.smrj.go.jp/english/index.html
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2. Information on Joining this Business Meeting Event
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Specify the purpose of participating in this business meeting event.
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What are your 3 main goals for this business meeting event?
Please select up to 3 choices from 1-9 below and provide details of your objectives.
Please also indicate the target areas in which you would like to collaborate with Japanese companies.
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1. Purchase parts/products
2. Distributorship Agreement / Sell Japanese products
3. OEM (order to Japanese companies)
4. Co-development, technical collaboration
5. Establishment of Joint-venture（In your country and third party country）		6. Exchange information
7. OEM (order from Japanese companies)
8. Sell parts to Japanese companies
9. Other
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Meeting Purpose （１） (Required)*Describe in detail what type of Japanese company and what kind of business meetings you would like to have approximately in 100 words.counter
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Please select0
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Describe the targeted area of technology, product or service for collaboration. (Required)
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Meeting Purpose (2)*Describe in detail what type of Japanese company and what kind of business meetings you would like to have approximately in 100 words.counter
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Please select0
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Describe the targeted area of technology, product or service for collaboration.
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Meeting Purpose (3)*Describe in detail what type of Japanese company and what kind of business meetings you would like to have approximately in 100 words.counter
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Please select0
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Describe the targeted area of technology, product or service for collaboration.
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sample 1
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Meeting Purpose*Describe in detail what type of Japanese company and what kind of business meetings you would like to have approximately in 100 words.counter
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1. Purchase parts/products 		Our company imports and sells mainly medical equipment for use in ICUs and operating rooms. Our company is interested in dealing with any Japanese manufacturers or distributors who can supply those innovative medical devices that complement our current product line-up and can be locally distributed at a premium price through our nationwide sales network. The devices must be authorized with Japanese medial license and CE-marking approval is desirable.68
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Describe the targeted area of technology, product or service for collaboration. Any value-added Japanese medical devices particularly in the field of ICU, critical care and operating units, such as ventilators, anesthetic system and endocsopic surgry instrument having unique features.　
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sample 2
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Meeting Purpose*Describe in detail what type of Japanese company and what kind of business meetings you would like to have approximately in 100 words.counter
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5. Establishment of Joint-venture（In your country and third party country）We are originally a leading importer of intravenous catheters and other medical disposables mainly relating to surgical operations. Last year, we acquired our own manufacturing capability of medical disposable products including XX SQM clean rooms. Half of the clean room areas is still open for new business. Now, we are looking for a new Japanese partner who are interested in establishing joint venture for local manufacturing and supply through a long term relationship. We can flexiblely discuss stepwise collabollation, e.g. importation of finished products and/or technical lincences as first step and joint venture as ultimate goal, if appropriate. 98
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Describe the targeted area of technology, product or service for collaboration. Medical disposable devices used for such applications as laparoscopic operation, wound care, CSSD, safety syringe, safety infusion sets, PCI and PTCA
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sample 3
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Meeting Purpose*Describe in detail what type of Japanese company and what kind of business meetings you would like to have approximately in 100 words.counter
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4. Co-development, technical collaboration We are a manufacturer specialized in the implant devices and components for orthopedics surgery such as hip joint, knee joint and spine. We are now looking for a Japanese partner who has outstanding technology, knowhow and patents in that field and who is keen to jointly develop more robust and biocompatible implant devices/components to meet various customers' needs. We currently own plenty of relevant patents and we like to discuss about transferring of our patents to Japanese companies or making cross licences each other. Discussions on any types of technical collaboration and/or joint development is highly welcomed.97
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Describe the targeted area of technology, product or service for collaboration. Innovated implant devices/components for orthopedics surgery and its related technology for joint development and technical collaboration
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3．Business Outline
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Provide the business outline of your company.
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Business Area and Percentage of Sales (Required)Sample) Manufacturing 70%, Trading 20%, Other(Service)10%
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(1) Your Main Product /Service in the Business Area （Required）Sample) Diagnostic imaging systems（Xray-CT. MRI, Ultrasound）Type of Supplier
(Scope of your business) （Required）

Select "☑" for All that Applies

Manufacturer
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Trader
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Wholesale
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Other
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(2) Your Second Product /Service in the Business AreaSample) Cardiac and vascular treatment device（Balloon Catheter, Coronary Stent, Graft）Type of Supplier
(Scope of your business)

Select "☑" for All that Applies

Manufacturer
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Trader
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Wholesale
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Other
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(3) Your Third Product /Service in the Business AreaSample) Hospital equipment and facilities(Sterilizer, Medical bed, Operating table)Type of Supplier
(Scope of your business)

Select "☑" for All that Applies

Manufacturer
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Trader
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Wholesale
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Other
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Main Client Industry(s) (Required)Sample) Medical Users(General hospital, Dental clinic), Medical device manufacturer
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Main Client(s)
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Please provide a business summary to promote your company, including special features of your company, business history, strengths, products or services.(Minimum of 100 words) （Required）counter
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Certifications (Required)

Select "☑" for All that Applies		ISO9001ISO14001ISO13485
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CE-MarkingUS FDANone
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Other certification relating to business matching
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If you select "Other certifications relating to business matching", please specify what type of certification.
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Future Business Plan and Investment Plan If Any
（Required）
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