Letter of Proxy
委任状
Year
20
(Representative
Month
年
月
Date
日
Information) 代理人
Address:
N a m e:
P h o n e:
I assume the person listed above an agent, and entrust the aforementioned
agent in regard to the following certificate.
私は上記の者を代理人と定め、下記の事項を委任します。
・
・
・
( Applicant Information)
本人
Address:
Personal Seal
Signature:
印
○
Must be written by the applicant
Date of Birth:
/
/