To Overseas Department Date 10.01.2018.

Request for Gohonzon Bestowal

Applicant (Please fill out Print)

Name of Applicant Sanja Majic
Signature of Applicant
Address 13/5 Gillespie Crescent, EH10 4Ht, Edinburgh, UK

Phone (Home) 07749 759268 (Work)

Occupation Artist, market assistant Date of Birth 15.03.1979.

Name of Sponsor Kaori Simpson

Signature of Sponsor
Address 22 Ashville terrace, EH6 8DD, Edinburgh, UK

Phone (Home) 07531 927047 (Work)

Occupation Director at Harajuku Kitchen

Name (s) of Family member Dates of Birth Gojukai Date Kankai Date Relationship

19/5/17

Memo

Signature by Priest