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["JAPAN　KARATE　ASSOCIATION"]
[]
["Examination form 【Qualification】　"]
[]
["（Ｆｉｌｌ　ｉｎ　ｔｈｅ　ｉｔｅｍｓ　ｂｅｌｏｗ　ｃｏｍｐｌｅｔｅｌｙ）"]
["Date of Examination :            /    　   /           * (yyyy/mm/dd)"]
[" Ｎａｍｅ"]
[" Ｎａｔｉｏｎａｌｉｔｙ"]
[" Ｄａｔｅ　ｏｆ　Ｂｉｒｔｈ","          /       　   /             * (yyyy/mm/dd)",null,null,null," Ａｇｅ"]
[" Ｏｒｇａｎｉｚａｔｉｏｎ　Ｎａｍｅ"]
[" Ｍｅｍｂｅｒｓｈｉｐ　Ｎｕｍｂｅｒ","         -          -          - ",null,null,"Expiration date","             /         /"]
[" Ｐｒｅｓｅｎｔ　Ｒａｎｋ"," 　　　Ｄａｎ ","Ａｃｑｕｉｓｉｔｉｏｎ　ｄａｔｅ ：　         /         　/          * (yyyy/mm/dd)"]
[null,null," Ｒｅｇｉｓｔｒａｔｉｏｎ　ｎｕｍｂｅｒ ："]
[]
[" Ｈｏｌｄｉｎｇ　Ｌｉｃｅｎｓｅ　"," Ｉｎｓｔｒｕｃｔｏｒ",null,"Ｅｘａｍｉｎｅｒ",null,"Ｊｕｄｇｅ"]
[]
["Acquisition date","/        /",null,"/         /",null,"/        /"]
[]
[]
[" Ｔｅｓｔｉｎｇ　Ｌｉｃｅｎｓｅ"," Ｉｎｓｔｒｕｃｔｏｒ",null,"Ｅｘａｍｉｎｅｒ",null,"Ｊｕｄｇｅ"]
[null,"Ａ",null,"Ａ",null,"Ａ"]
[null,"Ｂ",null,"Ｂ",null,"Ｂ"]
[null,"Ｃ",null,"Ｃ",null,"Ｃ"]
[null,"Ｄ",null,"Ｄ",null,"Ｄ"]
[{"$nulls":4},"Examiner’s \nname"]
[]
[]
["（Ｆｏｒ　ｔｈｅ　ａｄｍｉｎｉｓｔｒａｔｉｏｎ　ｏｎｌｙ）",null,null,"* Examiner　should circle PASS / FAIL.   "]
[" Result","PASS","FAIL","PASS","FAIL","PASS","FAIL"]
[" Scoring"]
[" Ｅｘａｍ　Ｆｅｅ"]
[" Ｒｅｇｉｓｔｒａｔｉｏｎ　Ｆｅｅ"]
[" Ｎｏｔｅ"]
["This paper will never be passed on to third parties."]