YY/MM/DD

Director General for Disarmament, Non-Proliferation and

Science Department, Ministry of Foreign Affairs of Japan

(Applying Organization)

Postal code: －

Address:

Organization name: Seal

Title of representative:

Name of representative:

Telephone number:

Name of responsibleperson:

Application to the Ministry of Foreign Affairs of Japan for

“Youth Communicator for a World without Nuclear Weapons”

Wesubmit this application form and other designated documents to the Ministry of Foreign Affairs of Japan to apply for “Youth Communicator for a World without Nuclear Weapons”.

Shouldassigning the titlebegranted, we pledge to observe the matters specified under6. below. In the event that the Ministry of Foreign Affairs of Japan findsany violation of this pledge, we will raise no objection to revocation by the Ministryof permission to use the title.

  1. Name of host organization
  1. Project title
  1. The name of the applicant for “Youth Communicator for a World without Nuclear Weapons”
  1. Period of the project
  1. Venue of the project
  1. Matters to be observed

(1) The host organization (and the applying organization) shallbe completelyresponsible for the project and shallpay careful attentionto safety in carrying out the project.

(2)The hosting organization shallnot engage in political activity, religious activity, or any other activities or actions contrary to the purpose of the project.

(3)The opinions expressed by the “Youth Communicatorfor a World without Nuclear Weapons” during these occasions do not necessarily represent the views of the Japanese government.

(4)If the project involves participants from Taiwan or any other region, etc. with which Japan does not have diplomatic relations, the organization shallfollow the instructions given by the Ministry of Foreign Affairs of Japan

(5)The project shallbe non-profit and be carried out in thepublic interest, and the organization shallnot engage in coercion in relation to the solicitation of donations, the provision ofassistance or participationin the project.

(6)The project shallbe carried out in line with the outline containedin the document attached to the application form. If the organization intends to make any changes due to an unavoidable reason, it shallprovide notification to that effect immediately.

(7)The organization shallsubmit a report promptly after the project period.