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I do hereby make the provincial claim to allow the applicant pass freely in Kusagakure no Sato without hindrance and afford the bearer such assistance as may be necessary

Name: Akatsuki
Gender: Female
Age: Mid-20s.

To your knowledge, does the applicant possess any kekkai genkai, bloodline, clan status, possess unnatural knowledge or habour unsafe cultural practise Y/N? Y.
To your knowledge, is the applicant aware of any criminal charges against them? Y/N? N.
To your knowledge, are there any crimes discharged against them arisen from their behaviour? Y/N? N.
To your knowledge, is the applicant fleeing, seeking asylum, avoid persecution or seeking protection as is offered by Kusagakure no Sato? Y/N N
What are the provincial claims to heritage, history or conflict does the applicant have? Provide locale and period of time in any excess of a year. Applicant has not had extended leave in any particular country.

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What security clearance are you suggesting for the applicant? Wanderer status with leave to remain, own an abode and bare the mark of Kusagakure no sato as an affiliate.
Has the applicant consented to interview? Without this, the applicant will be automatically denied. Y/N. Y.
Does the applicant subscribe to any religious ideology? If so, please complete annex 41a and attach it to this application: Yes. Form 41a attached.
Please provide a character reference in the box below: Provided as a separate file.
Please provide a photo of the individual: Provided as a separate file with this application.
Does the applicant have any supporting evidence or character references that can be interviewed or provide supporting evidence? If Y, provide details

Hakaku Hirabayashu has been a mentor to the applicant and has known the applicant for a number of years. Hirabayashu-san has been approached and has confirmed willingness to provide witness and testimony to the character of the applicant.

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Submittant of the application? Junichi Sozin
Does the submittant have any undue stresses caused unto them by the nature of this application? Y/N. N.
Does the submittant need to make the investigatory and civil servant of Kusagakure panel (ICSK) aware of any other factors, elements, comments or declarations that may not be included under purview of this application? N.

Signed,
JUNICHI SOZIN
ジュニチ・ソジン

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A number of signed documents have been included with the application