Form 1-3 (Related to Article 3, Clause 4)

Application Form for Use of Confidential Datasets
(For use by External Applicants)

To: Confidential Datasets Control Manager, RIETI

Signature:					
Name of External Applicant (Print): 					
Date:    								

I hereby apply for permission to use Confidential Datasets in your possession for the research stated below, and notify the designation of a Confidential Datasets Manager and users1 from among the participants of the research as follows:

Name of the Research2:

External Applicant’s name, affiliation3, title, and contact details:

Name of the Confidential Datasets for which the External Applicant is seeking permission:

Confidential Datasets Manager’s4 name, affiliation, title, and contact details:

1	The Confidential Datasets Manager and users whose names are listed in this application form (called “Listed External Users”) shall be obliged to appropriately manage the Confidential Datasets according to Article 4 of the RIETI Regulations Regarding the Protection and Management of Confidential Datasets.
2	Please attach a brief summary of your research plan.
3	Please attach a brief description of the affiliated research institute.
4	Please appoint either yourself or one of the research participants.

Users’ names, affiliations, titles, and contact details:

Purposes of use5:

Period of use:

Location of use6:

Method of use7:

5	Please also note why use of the Confidential Datasets is necessary in your research and the manner in which your results will be disclosed.
6	Please include the identification codes, numbers, etc. of the PCs and other devices to be used.
7	Please clearly specify the form in which the data are to be used (paper, CDs, DVDs, etc.) and whether or not the data are to be made available online.