URUHA

RUSHIA

MAKAI

MAKAI

Tokyo-to Itabashi-ku Cover Corp's Office

Tokyo-to Itabashi-ku

Tanigo Motoaki

Kazuyuki Fukuda CTO, Cover Corp.

Yasuyuki Papa

Eldest

First Marriage

Father

Marriage Registration

Husband-to-be

Wife-to-be

Residence

Birthplace

(In the case of a foreigner, please only write the country name.)

(Your current place of residence.)

Witnesses

TANIGO

FUKUDA