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To: President of World Shitoryu Karatedo Federation
Application for DANI [ ] – Dan
WSKF Certificate
DATE: ___________________
NAME
Family Given Middle
Mr [ ] Mrs [ ] Miss [
]: ________________________________________________________________
DATE OF BIRTH
(Y/M/D) __________/______________/______ NATIONALITY: _________________
NAME OF YOUR ORGANIZATION OR SCHOOL FOR KARATE:
__________________________
YOUR SENSEI:
_________________________________________________________________________
THE LAST SCHOOL
(School or University Name) :
__________________________________________
PRESENT ADDRESS:
____________________________________________________________________
______________________________________________________________________________________
The day that you joined SHITORYU
(year) ________ (month) _______________ (day)__________
Your Sensei
[Beginning] _______________________________ [Present]
_______________________
YOUR DANI OF M.A.S.K.
[ ] - Dan Authorized Number [
______________] Date [ _______ / ______ /
________ ]
(A Photocopy of your DANI Certificate and Pass Book for
Verification)
Your Results of Tournaments
(chronologically)
|
DATE (Y/M/D) |
Name of the tournament |
Result (concretely) |
|
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(If you have more,
please use another A4 size paper)
Your Coaching History
(chronologically)
|
DATE (Y/M/D) |
Place |
Remarks |
|
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|
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(If you have more, please use another A4 size paper)
HISTORY OF DANI
|
DANI |
The Date of Issue
(Year / Month) |
The Person who issued your DANI |
|
Shodan |
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Nidan |
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A GUARANTOR OF YOUR HISTORY ABOUT KARATEDO (Your Sensei)
Name: _______________________ Relationship:
__________________________ Tel: ___________
Address:
____________________________________________________________________________
THE ORGANIZATION THAT APPLY FOR YOUR DAN CERTIFICATE
Name of the Organization:
_______________________________ National:
_________________
Name of the President:
_____________________________________________________
Signature of the President:
_________________________________ Organization Chop: |
