Release of Liability

To: Consulate General of Japan in New York

I will not hold the Consulate General of Japan in New York liable for any loss or
damages of my documents while being transported to or from the Consulate by mailing
services.

I take full responsibility for the transportation of these documents.

Print Name in full: _______________________ _______________________ ______________

(Surname) (Given name) (Middle name)

Date: ________________

Signature: _____________________________

***** Your signature here must be exactly the same as in your passport.