Confirmation Form to Verify User’s Understanding of Confidentiality Protection Issues

To: Confidential Datasets Control Manager, RIETI

Date:	   __________    
Name of the External User:    _____________    (Print)
							     __________    (Signature)

I hereby certify that the following statements are true:
* Tick the box next to each of the statements that apply.
☐(1)	I have never made unauthorized use of, or otherwise misused, any data subject to confidentiality protection, nor have I ever been found—whether by the faculty council to which I belong or by any other organization—to have engaged in any such conduct.
☐(2)	I have never misappropriated academic articles, nor have I ever been found—whether by the faculty council to which I belong or by any other organization—to have engaged in any such conduct.
☐(3)	I have never misappropriated research funds such as the Grant-in-Aid for Scientific Research by the Ministry of Education, Culture, Sports, Science and Technology, nor have I ever been found—whether by the faculty council to which I belong or by any other organization—to have engaged in any such conduct.
☐(4)	I do not personally know any individual or relatives of such individual surveyed for JSTAR.
☐(5)	I have never interfered or attempted to interfere with the implementation of JSTAR, nor have I ever engaged in any act that was deemed or construed as any such attempt.
☐(6)	I do not object whatsoever to RIETI suspending the use of the datasets and/or suspending publication of the academic article for which the datasets are being used, notifying the relevant authorities, requesting such authorities to conduct an investigation of the situation, and reporting to the judicial authorities in the event I make any false statements regarding (1)–(5).

Note:	Not only the applicant but also each of the listed users must file this form duly signed by hand.