(Form４)
Overseas Business Trip, Overseas Study Tour,
Trip Leave, Dispatched Employee Statement
　Name	Affiliation and Official title	
	
		Name of Organization	
Domestic contract information
 after going abroad and 
relationship with subject
	Address 

Name                       Relationship with traveler        (Tel          )	
	
Objective of travel		
NINS	
Effect on main business		

Destination country of 
travel

	
Transit 
country

	
	
Travel schedue	 As opposite side of this paper or as per Exhibit	
	
Period of Travel	        From mm dd, yyyy	         To mm dd, yyyy	
	
	       mm dd, yyyy – mm dd, yyyy	
	
Source of expense	        Traveller	Expenses for stay	

		

	
Measures such as substituting 
employee to the 
job vacated by the 
subject person	 	

Period Change, Addition of Destination Country
Cancellation of Travel, etc.　Statements
Period of Travel after change	From mm dd, yyyy	         To mm dd, yyyy	
	
	 mm dd, yyyy- mm dd, yyyy	
	
Added destination country		

Reasons for change, addition or 
cancellation		

Draft No. of the relevant Travel and 
decision date	No.              mm dd, yyyy