## AGENCY NOMINATION AND CERTIFICATION

## Source details

**Canonical URL:** [AGENCY NOMINATION AND CERTIFICATION](https://www.imf.org/-/media/files/oap/jispa/agency-nomination-and-certification.docx)

## Other formats

- [Markdown version](/-/media/files/oap/jispa/agency-nomination-and-certification.docx.md)
- [Structured JSON version](/-/media/files/oap/jispa/agency-nomination-and-certification.docx.json)

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### Nomination and applicant attestations
- I, the undersigned (name of agency representative) ____________________________, _______________________  
  Surname				  Given name
  acting on behalf of (name of agency) _____________________________________________________
  hereby:
  - 1. nominate (name of applicant) ____________________________,  _______________________  
    Surname				      Given name
    for graduate studies under the Japan-IMF Scholarship Program for Asia;
  - 2. certify that, to the best of my knowledge, the information supplied by the applicant is correct;
  - 3. certify that, to the best of my knowledge, the applicant has no record of misconduct, has not been subject to disciplinary action, and has no criminal conviction; and undertake to promptly notify the JISPA Secretariat should I become aware of any misconduct, disciplinary action, criminal proceedings, or other material information that may affect the applicant's suitability for the JISPA.

### Employment, leave, and duties commitments
- 4. certify that the applicant, if accepted, will receive a leave of absence for the duration of his/her studies in Japan under the JISPA and upon return will be employed:
  - as (title of position) ____________________________________________________________
  - in (name of agency) ____________________________________________________________
- 5. certify that the applicant, if accepted, will not be assigned duties that will conflict with devoting full time and attention to his/her studies;

### Health, repatriation, and assistance
- 6. certify that my agency will assist in the applicant’s repatriation if any personal difficulties or circumstances arise during his/her studies that make repatriation desirable or necessary;
- 7. certify that the applicant, if accepted, will undergo a comprehensive medical examination immediately before arriving in Japan, to ensure that he/she is in good health, free from any contagious disease, and free from any medical conditions that would impair his/her studies;

### Financial guarantee, signatures, and contact details
- 8. guarantee, in addition, that the IMF will be reimbursed promptly by my agency for all expenses incurred as a result of any of the conditions mentioned in 5 and 6 above, as well as for any medical expenses not covered by medical insurance.
- Agency Representative’s Signature _______________________________________
- Official Seal
- Date ________________________ (MM/DD/YYYY)
- Name: Dr./Mr./Ms. ______________________, _______________________  
  Surname		          Given name
- Title: _______________________________________
- Department: _______________________________________
- City: ___________________________Country: _________________________
- Tel. ____________________________ Email ____________________________

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_Source: https://www.imf.org/-/media/files/oap/jispa/agency-nomination-and-certification.docx_