Received by NSD/FARA Registration Unit 01/25/2018 7:25:44 PM
OMB No. 1124-0005; Expires May 31,2020

u.s. Department of Justice

Short Form Registration Statement
Pursuant to the Foreign Agents Registration Act of
1938, as amended
___ _____
_____

Washington, dc 20530

INSTRUCTIONS. Each partner, officer, director, associate, employee, and agent of a registrant is required to file a short form registration statement
unless he engages in no activities in furtherance of the interests of the registrant's foreign principal or unless the services he renders to the registrant
are in a secretarial, clerical, or in a related or similar capacity. Compliance is accomplished by filing an electronic short form registration statement
Privacy Act Statement. The filing of this document is required for the Foreign Agents Registration Act of 1938, as amended, 22 U.S.C. § 611 etseq.,
for die purposes of registration under the Act and public disclosure. Provision of die information requested is mandatory, and failure to provide the
information is subject to the penalty and enforcement provisions established in Section 8 of the Act. Every registration statement, short form
> registration statement, supplemental statement exhibit, amendment, copy of informational materials or other document or information filed with die
Attorney General under this Act is a public record open to public examination, inspection and copying during the posted business hours of the
Registration Unit in Washington, DC. Statements are also available online at the Registration Unit’s webpage: https://www.fara.gov. One copy of
every such document, other than informational materials, is automatically provided to the Secretary of State pursuant to Section 6(b) of the Act, and
copies of any and all documents are routinely made available to other agencies, departments arid Congress pursuant to Section 6(c) of the Art. The
Attorney Geheral also transmits a semi-anniial report to Congress on the administration of the Act which lists the names of all agents registered under
the Art and the foreign principals they represent This report is available to the public and online at: https://www.fara.gov.
Public Reporting Burden. Public reporting burden for this collection of information is estimated to average .429 hours per response, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden to. Chief: Registration Unit, Counterintelligence and Export Control Section, National Security Division, U.S. Department of
Justice, Washington, DC 20530; and to the Office of information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
2. Registration No.

1. Name
Ai Kuriyama

1833

3. Residence Address(es)

4. Business Address(es)

630 S. Masselin Ave. #201
Los Angeles, CA 90036
5. Year of Birth
Nationality

777 S. Figueroa St Suite 3750
Los Angeles, CA 90017

1986

6.

If present citizenship was not acquired by birth,
indicate when, and how acquired.

Japanese
N/A

Present Citizenship Japan
7. Occupation Director of Business Development Section
8. What is the name and address of the primary registrant?
Name JETRO Los Angeles

Address 777 S. Figueroa SL Suite 3750
Los Angeles, CA 90017

9',"’Indicate yp^ conriectioh with the pnmaiy registrant:
□ partner

□ director

□ officer
□ other (specify)

□ associate

0 employee
. □ agent

Q consultant
□ subcontractor

10. List every foreign principal to whom you will render services in support of the primary registrant.
Japan External Trade Organization (JETRO)
Ark Mori Building, 1-12-32 Akasaka, Minato-ku, Tokyo 107-6006 JAPAN
11. Describe separately and in detail all services which you will render to die foreign principal(s) listed in Item 10 either directly, or
through the primary registrant listed in Item 8, and die date(s) of such services. (Ifspace is insufficient, afull insert page must be
used.)
N/A

FORM NSD-6
Revised 05/17

Received by NSD/FARA Registration Unit 01/25/2018 7:25:44 PM

 Received by NSD/FARA Registration Unit 01/25/2018 7:25:44 PM
12. Do any of the above described services include political activity as defined in Section l(o) of the Act and in the footnote below?
Yes □
NoS
If yes, describe separately and in detail such political activity.

13. The sCTvices'described in ltems 11 and‘12 are'to'be rendered on a'
El full time basis
O part time basis

G special basis

14. What compensation or thing of value have you received to date or will you receive for the above services?
0 Salary: Amounts
per mon^
Q Commission at%of
G Salary : Not based solely on services rendered to die foreign principal(s).
Q Fee: Amounts___________

Q Other thing of value

IS. During the period beginning 60 days prior to the date of your obligation to register to the time of filing this statement, did you
make any contributions of money or other things of vaiue from your own funds or possessions and on your own behalf in
connection with any election to political office or in connection with any primary election, convention, or caucus held to select
candidates for any political office?
Yes G
No El
If yes, furnish the following information:
Date

Amount or Thing of Value

Political Organization or Candidate

Location of Event

EXECUTION
In accordance with 28 U.S.C. § 1746, the undersigned swears or affirms under penalty of perjury that he/she has read the
information set forth in this registration statement and that he/she is familiar with die contents thereof and that such contents are in
their entirety true and accurate to the best of his/her knowledge and belief.
January 25,2018
(Date ofsignature)

/%/

Keiichi Nishimoto

eSigned

(Signature)

Footnote: "Political activity," as defined in Section l(o) of tlu Act, means any activity which the poson engaging in believes will, or that the person intends to, in any way influence
any agency or official of the Government of the United States or any section of the public within the United States with reference to formulating, adopting, or changing the
domestic or foreign policies of the United States or with reference to the political or public interests, policies, or relations of a government of a foreign country or a foreign political
P«ty.

i

Received by NSD/FARA Registration Unit 01/25/2018 7:25:44 PM