Subject：【App. for Digitization】

Body：
To Director of 　　　　　Library, University of Tokyo

　Name：
　Affiliation：
　Status：
　UTokyo Account :
　Student ID：
　E-mail address:

I hereby request the digitization of the following materials which is based on 
the copyright law of Japan (article 37.3). For the usage of the digitized data, 
I pledge to comply with the law, and not to duplicate or distribute to a third party.

　Title :
　Author：
　Publisher：
　Journal Title：
　Volume / Number / Year：
　The range of digitized：
　File Type：
　Receiving Method：File transfer service (recommended) / CD-ROM / Other
　Note :