Application form for Using Facilities at the Japan Foundation, Jakarta
To Mr. Yuichi TAKAHASHI
Director General of the Japan Foundation, Jakarta
On behalf of __________________ (organization’s name), I would like to apply forusing the facilities at the Japan Foundation, Jakarta, as the details are as follows:
1. Applicant
1) Name of organization:2) Representative’s name:
3) Address:
4) Phone number:5) Contact person:
Phone number:
E-mail address:
2. Preferred date and time for usage:
3. Name of Project:
4. Facility to be used (1st Floor) ※Please select□ Hall “Sakura”□ only A (65 ㎡) | maximum capacity for 50 persons□ only B (65 ㎡) | maximum capacity for 50 persons□ A and B (130 ㎡) | maximum capacity for 100 persons□ Meeting room “Momiji”（30 ㎡, Maximum capacity for 13 persons）□ Meeting room “Asagao”（25 ㎡, Maximum capacity for 12 persons）
5. Expected number of participants (including organizers and speakers):
6. Additional equipment to be used (if any):Notes:* Please send the application form and letter of consent to komunikasi@jpf.go.jp two (2) months prior to theevent schedule.
*Please attach the event outline and brochure of the organization when submitting the application.
* The event should be non-commercial and free of charge in accordance with the mission of The JapanFoundation, Jakarta as a non-profit organization.
* The applicant will cover the building overtime surcharges when the event runs past The Japan Foundation,
Jakarta office hour. (The Japan Foundation, Jakarta office hours: Monday – Friday | 8.30AM – 4:30PM)

DATE_______________
NAME_______________
SIGNATURE_______________

TO THE JAPAN FOUNDATION JAKARTALETTER OF CONSENTI HEREBY AGREE TO THE FOLLOWINGS IN RELATION TO THE USAGE OF THE
FACILITIES AT THE JAPAN FOUNDATION, JAKARTA.

1. What have written on the Application Form for Using Facilities at JF Jakarta (or,the Form) are all true and correct.
2. I understand the mission of the Japan Foundation, Jakarta, and I will not utilize
the facilities in other activities than written on the Form.
3. I and my organization will be responsible for preparing and finishing thefacilities before and after the event, and for making the facilities as the same
as before when the event is over. In case I or my organization fail to meet thisrequirement, I agree that the Japan Foundation, Jakarta will make the facilities
as the same as before and the financial costs for making so will be paid by myorganization.
4. In case of using the Hall on the 1st floor, I and my organization will beresponsible for employing 2 security guards and to make the best effort for thesafety of the participants, as well as any loss or damages incurred during theperiod of the venue was occupied, my organization will bear all theresponsibility including legal one.
5. In case of loss or damages to the facilities occurred by the organizers orparticipants of the event, my organization will take responsibility of making thefacility as the same as before the loss or damages, and the financial costs forthe recovery should be covered by my organization.
6. Within 2 weeks after the event, I will submit a project report to the JapanFoundation, Jakarta.

DATE _______________ORGANIZATION’S NAME ________________REPRESENTATIVE’S NAME_______________
SIGNATURE_____________________________