Disaster Relief Donation for the Indonesian Earthquake
Application Form
○○○○All blanks must be completed
DATE:
To the President of Hiroshima University
Ochi Mitsuo
Faculty / Department
____________________________________________________________
Name ______________________________________________________
Contact ( Tel or E-mail) _________________________________________
Donation Amount JPY
……………………………………………………………………………………………………
Receipt
DATE:
To
This is to acknowledge that we received
JPY
as a relief donation for the Indonesian earthquake.
President, Hiroshima University Ochi Mitsuo
Official seal of President,
Hirosima University
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