Examination Application Power of Attorney

Power of Attorney

I hereby appoint Mr. Tsutomu Kurita, representative of Limited Liability Company Rivreboting, as my proxy and delegate the following matter.

Japanese calendar today

令和7年04月02日

Japan
※National exam date you applied for
Reiwayearmonthday
※National exam site you applied for

※Type of national exam you applied for
An application about the boat’s operator’s examination and all matters about the receipt of the
document.

To
Boat’s Operators Examination Agency
Japan Marine Recreation Association

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

Address1

Address2

Please fill in the form as per your certificate of residence.
Your name (required)
Your Email(required)