Power of Attorney for License Application

Power of Attorney

I hereby appoint Mr. Tsutomu Kurita, Maritime Agent, as my proxy and delegate the following authorities.

1.All matters related to applications based on the Seafarer’s Act and related regulations, as well as the receipt of a Small Vessel Operation Permit.

Japanese calendar today

令和6年05月02日

Please fill your name in the form as it appears on the residence certificate(Japnease Juminhyo).
If you do not know how to write ”furigana”, you may leave it blank. We will ask you at the class.
Furigana–Japanese pronunciation written in katakana or hiragana

    Zip code (7 digits - Address 1 auto-fill)

    Address 1


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