REQUEST FORM FOR PHOTODUPLICATION	
Instructions for applicant
1.	This request form must be legible and preferably typed.
2.	A separate order must be made for each item.
3.	Please include requests for a particular format (e.g., microfilm) or other additional information in the Notes column.

Conditions for photoduplication
1.	The applicant assumes full responsibility for any problems related to copyright protection that might arise from the use of this photoduplication service.
2.	Materials from the collections of the NDL will be copied and supplied for personally study or research. 
	
NDL User ID	Name of applicant (individual / library / institution etc.)	
									-				
Address of applicant:	Name of client (of the library / institution etc.)	

Country name:

Postal Code (if any):

E-mail　　　　　　　　　　　　　　　Fax　　　　　　　　　　　　Phone	
Purpose of photoduplication	□	for study or research  
□ for other purpose*（　　　　　　　　　　　　　　   ）	
	
Enter the portion to be copied	
Call no. / ISBN・ISSN / Ref. source etc.

（Provide persistent ID of digitized material）
info: ndljp/pid/　　　　　	Title of article

Author

Pages 

□ Cover　　□ Table of Contents　　
□ Colophon (publication data)	
Title of periodical or book

Year　　    Volume          Number		
Publisher		
□ Copy colored pages in color　　□ Agree that letters and images may be unclear	
Notes or additional information	
	
*National Diet Library use only