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In certain cases, we may not be able to provide samples to overseas countries even if an inquiry is made.

Before contacting us, please read about the usage process and sample provision period.

*Required field

1. Contact address

We confirmed the usage process and the period until sample provision.

（Click here for reference page）*

Name*

Organization*

E-mail*

Phone

Subject*

2. Biobank network id
In order for NCBN to provide you with a more appropriate response, please answer the following questions to the best of your ability regarding the type of sample you would like to use and your research.
When inquiring about results from the Biobank Cross-Search System, please include the collaborator ID. For collaborator IDs corresponding to NCBN samples, enter them as 6NC followed by 10 alphanumeric characters. （Example：6NC0000000001） ※The ID is a 6NC + 10-digit string. ※Please enter using half-width alphanumeric characters. ※Please separate each ID with a comma, space, or line break.
3. Desired form of provision
Joint Research Sale (= non-joint research) Other (please fill in the details if you wish) Undecided ※Depending on the content of the sample you wish to receive, NCBN may propose providing the sample in a format different from your request.
4. Items related to diseases
Disease name
Request for samples from healthy individuals	Yes None
If you choose a healthy person specimen "Yes", please list the conditions for healthy people below.
5. Items related to the content to be provided ※In principle, we do not handle samples from foreign registrants.
5-1. Content to be provided
Sample only (e.g., serum specimen only, no disease or gender information required) Information only (e.g., patient information and additional medical information, no sample required) Both samples and information
5-2. Type of sample to be provided
Live cells_peripheral blood Living Cells_Bone Marrow Fluid Live Cells_Cord Blood Live cells_cell lines (including iPS strains and EBV-LCL) Body fluids, etc._plasma Body fluids, etc._serum Body fluids, etc._urine Body fluids, etc._Feces Body fluids, etc._Spinal fluid Body fluids, etc._Body fluids (pleural effusion, ascites, sputum, amniotic fluid, etc.) Tissue_Non-lesional tissue Tissue_Lesion_Non-tumor tissue Tissue_Lesion_Tumor Tissue Obstetric-related tissues (placenta, villi, umbilical cord, etc.) Nucleic acid _DNA (germline/somatic) Nucleic acid _RNA (germline/somatic) Others If you selected "Other" above, please describe it in detail below
5-3. Samples, number, quantity, etc.
Desired number of samples （Sample）
Desired amount per sample （Please fill in units such as uL, mL, g, etc.）
Timing of sample collection
If you selected "Other" above, please describe it in detail below
5-4. Content of information to be provided
Gender Age Anamnesis Family history Drinking and Smoking Information The name of the main disease Coexisting disease names Drug administration information Inspection Information History of special treatment Clinical information Analysis Data If you selected "Clinical Information" or "Analysis Data" above, please describe it in detail below
6. Items related to the outline of the study
6-1. Research Outline

6-2. Purpose of use of samples

Inquiry in detail (Up to 3000 words)

The personal information acquired through these inquiries will be handled in accordance with the Personal Information protection Policy.
Please confirm the contents, check "Agree", and then make your inquiry.

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