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[0.00]4媺鶴W0 1 媺鶴W0 15媺鶴W0 2 媺鶴W0 26媺鶴W0 3 媺鶴W0 37媺鶴W0 4 媺鶴W0 4 8茤姃茤 9鶴汻鶴汻 :瑠f噀5瑠f噀;€惃<€( 惃 [0.00] =eQ汻eQ汻€j杗>€ .  h圍yn0n0??????? ?o侱0o侱0XTableStyleMedium2PivotStyleLight16`鸯3u藠篘(u?K3u藠篘(u蠄 Qz3u藠篘(uで3u藠篘(uQQ   ;U!  ;R!"fNf?@€€€稷餳0 *#3 A@@  O'Year 5Month 5L3u藠篘I{\Ob(u 0000 0Yuf[0 H5??????????????????? &210恌[HQ"5??????^220頞f[t^pe \f[!h^gB}f[tk Z5????????????????????????? X230gB}f[tk 萐o0(Wf[-Nn0f[!h T5??????????????????????  .(1)(WM|秗羖*5 ??????????RSmi(Wf[-NOf[-N-N'Yf[b ZS隭 'Yf[b 頞隭 韜g'Yf[\€昮[!h貧I{f[!h-Nf[!h (2)f[!hT5??????)Date of graduation or expected graduation*f歬0??<f&5????????$ fT 5?????2 }萐o0筽pe.5 ?????????錯,g瀶Ye瞼?譙Q0_0Ye瞼_j蔛s0g摃_jT5?????g摃5??? 錯,g瀶n0Ye瞼萐o0錯,g瀶k0??Ye瞼?譙Q0_0Ye瞼_j蔛s0g摃5 ""??????????????????????????????????   B260辬(W粚n0/e_筫誰I{>5??????????????  0(3)L}粚/e_€,5???????? `$l0T5???$a$OO0@b 5????? @b$w€mi 銻賀HQn0T饄 <5???????????????? $c$t^0蜸 5?????L3u藠篘I{\Ob(u 0000 0Yuf[0 H5??????????????????? +Y籝6r蚹Vy6rVy蚹 ?r 櫷kDQ_蒠筜許6r /O6r ?許蚹/O蚹 譙eQYe瞼_j薙篘?鍂篘薙篘?鍂篘n0獕蟚諷_翺€?0WOmiI{w€酺諷_翺€?0WOmiI{w€酺n0獕蟚 (5)hYf[褢/ef}_j  N?1)g0hYf[褢?x悶bW0_04XTk0奺Q 5$$????????????????????????????????????   Y齎?e淾錯,g齎?e淾,0W筫lQqQ鉜SO(5 ?????????lQ蕍>y鉜誰篘萐o0lQ蕍鉜誰篘  ,270RSmi宊n0圢歔(5 ?????????0^0齎錯,gg0n02恌[錯,gg0n01\w€? 5'Yf[$(1)T0饄 5?????(麞q妀u鱏$5???????6:d/^麞q妀u鱏25 ????????????]0n0諲  (1)l0T5??? *(2),g篘h0n0翺&5????????$(3)OO0@b 5?????N錘 Nn0 弲Q筟o0婲焄h0鴙U怋0?~0[0?0J5?????????????????  L3u藠篘鉔t篘 n0rT3u藠鴉\Obt^g錯H5???????????????????    Agent or other authorized person哘5??鑜a5????(2)@b(W0W5?????((3)麞q妀u鱏$5???????t^5??g5??錯 5?; 0諷!k€g5??$(2)OO0@b 5?????2(3)@b^\_jI{.5 ????????? V(WYu菍(2)愌扄0:dL圛{n0%R:5 ???????????? *Y齎K0?n0:dL&5????????*Y齎K0?n0愌&5????????&:dL€"5??????&:dL圔fg"5??????Yen 5WFor applicant, part 2 P ("Student")  5" For certificate of eligibility 5Place of study 5Name of school 5Address 5Telephone No. 5V Total period of education (from elementary school to last institution of education) 5Years 58Education (last school or institution) or present school 5Registered enrollment 5 Graduated 5 In school 5Temporary absence 5 Withdrawal 5Doctor 5Master 5Bachelor 5Junior college 5College of technology 5\f[!h5???????  5Senior high school 5Junior high school 5Elementary school 5Others 5Name of the school 5Year 5Month 5Day 5 Japanese language ability (Fill in the followings when the applicant plans to study at advanced vocational school or vocational school (except Japanese language)) 5'Proof based on a Japanese language test 5Name of the test 5Attained level or score 5DOrganization and period to have received Japanese language education 5 Organization 5K0? 5~0g0 5Period 5from 5Year 5Month 5to 5Others 5250錯,g瀶f[tk 貧I{f[!hk0J0D0f0Ye瞼?譙Q0?4XTk0奺Q  5f Japanese education history (Fill in the followings when the applicant plans to study in high school) 5p Organization and period to have received Japanese language education / received education by Japanese language 5Organization  54Method of support to pay for expenses while in Japan 5>Method of support and an amount of support per month (average) 5Self 5Supporter living abroad 5Supporter in Japan 5 Scholarship 5Others 5(Remittances from abroad or carrying cash 5Carrying from abroad 5Remittances from abroad 5  5 Name of the individual 5Date and time of 5 carrying cash 5carrying cash 5 Supporter 5Name 5Address 5Telephone No. 5 Occupation (place of employment) 5Annual income 5&For applicant, part 3 P ("Student")  5Relationship with the applicant (Check one of the followings when your answer to the question 26(1) is supporter living abroad or Japan) 5Husband 5Wife 5Father 5Mother 5 Grandfather 5 Grandmother 5Foster father 5Foster mother 5Brother / Sister 5 Uncle / Aunt 5Educational institution<  5Friend / Acquaintance 5!Relative of friend / acquaintance 53Business connection / Personnel of local enterprise 5  5?Relative of business connection / personnel of local enterprise 5Others 5xOrganization which provide scholarship (Check one of the following when the answer to the question 26(1) is scholarship) 5Foreign government 5Japanese government 5Local government 5RPublic interest incorporated association / Public interest incorporated foundation 5Plans after graduation 5Return to home country 5* Enter school of higher education in Japan 5Find work in Japan 5 Others 5$280,gk0J0Q0?3u藠篘n0鉽w嫼N恌[HQL0-Nf[!h萐o0\f[!hn04XTk0奺Q 5 ,,????????????????????????????????????????????  %(!Name 5Relationship with the applicant 5Address 5Telephone No. 5Cellular Phone No. 5n Applicant, legal representative or the authorized representative, prescribed in Paragraph 2 of Article 7-2. 5Relationship with the applicant 5EI hereby declare that the statement given above is true and correct.  5KSignature of the applicant (representative) / Date of filling in this form  533u藠鴉\Ob宊3u藠~0g0k0 弲Q筟k0 Y鬴L0uX0_04XT 3u藠篘鉔t篘 L0 Y鬴噞@b?奵kW0  rTY0?S0h00 5 Attention 5In cases where descriptions have changed after filling in this application form up until submission of this application, the applicant (representative) must correct the part concerned and sign their name. 5Name 5Address 5'Organization to which the agent belongs 5Telephone No. 5P(3)RSmi萐o0RSmi媺紡0t^gL5??????????????????  2903u藠篘 誰歔鉔t篘 誰,{agn0,{榢0弶歔Y0?鉔t篘 51j(4)3u藠篘h0n0翺  N?1)g0(WYL}粚/e_€爩舃萐o0(W錯L}粚/e_€爩舃?x悶bW0_04XTk0奺Q   $f5?????????????????????????  Actual guardian in Japan0( Fill in the following if the applicant is to study at a junior high school or elementary school ) 5,240錯,g瀶齹汻 \頞f[!h萐o0T.zf[!hk0J0D0f0錯,g瀶Ye瞼錘Yn0Ye瞼?譙Q0?4XTk0奺Q 555?????????????????????????????????????????????????????   %( -#.&1)%R?{mQ鱏n0 N豬_,{mQagn0孨翺  !5 ???????????????????????????      <3u藠篘I{\Ob(u 85?????????????? <錯,g齎?e淾誰賀w85?????????????? For applicant, part 1 5(Ministry of Justice, Government of Japan 5(W0Yu0菍0KAPursuant to the provisions of Article 7-2 of the Immigration Control and Refugee Recognition Act, I hereby apply for the certificate showing eligibility for the conditions provided for in 7, Paragraph 1, Item 2 of the said Act. 5  50 5  5 410齎0M|?0W0遅05???????(20ut^g錯$5???????Nationality/Region 5Date of birth 5Year 5Month 5Day 5 Family name 5 Given name 530l0T 5Name  540'`0%R 57u5???? 5sY5??? 50鶴u0W5??????  560M憊P€n0 g!q g 5?? 5!q 5?Sex 5Male 5/ 5Female 5Place of birth 5Marital status 5Married 5Single 5&70w€0mi"5?????? .80,g齎k0J0Q0?E\OO0W*5 ?????????? Occupation 5Home town/city 5 ,90錯,gk0J0Q0?#恆}HQ(5 ?????????Address in Japan 5Telephone No. 5Cellular phone No. 5"100舉8R5????"(1)ju0鱏5????((2) g筊gP$5???????  5  Passport  5Number 5Date of expiration 5N110eQ齎顅剉 !kn0D0Z0?K0r奡_Y0??n0?x悡0g0O0`0U0D00 J5?????????????????  -Purpose of entry: check one of the followings 5? 5 ) 0Ye坈05????? ) 0Ye瞼0 * 0競S0* 0噀S;m誖0 5+ 0梉Ye0, 01XS0 5 "Professor" 5 "Instructor" 5"Artist" 5"Cultural Activities" 5"Religious Activities"  5 "Journalist" 5  M 0L}禪?t0 5 , , 0xvz鈳銻 0(5 ?????????"Intra-company Transferee" 5"Business Manager  5"Researcher (Transferee)" 5. 0€bS堺0篘噀鍂X孄0齎洊mi賀0. 0€b齹0 "Researcher" 5?"Engineer / Specialist in Humanities / International Services"  5"Skilled Labor" 5?  5R. 0yr歔;m誖xvz;m誖I{ 0N5???????????????????   / 0侺0 0 0Yuf[05?????1 0x頞0 Y 0€b齹焄鱏 0H"Designated Activities ( Researcher or IT engineer of a designated org)" 5"Entertainer" 5 "Student" 5  "Trainee" 5#  "Technical Intern Training ( i )" ! 5<  2 0禰蟚辬(W0 5^2 0yr歔;m誖xvz;m誖I{禰蟚 0Z5??????????????????????  2 0yr歔;m誖EPA禰蟚 0 "Dependent" 5T"Designated Activities (Dependent of Researcher or IT engineer of a designated org)" 5)"Designated Activities(Dependent of EPA)" 5 4 0錯,g篘n0M憊P€I{0  4 08lOO€n0M憊P€I{04 0歔OO€0&"Spouse or Child of Japanese National" 5'"Spouse or Child of Permanent Resident" 5"Long Term Resident" 5 0貧\€晈€鱏? 0 5 0貧\€晈€鱏? 0 5 0貧\€晈€1鱏? 0 55 0]0n0諲0#"Highly Skilled Professional(i)(a)" 5#"Highly Skilled Professional(i)(b)" 5#"Highly Skilled Professional(i)(c)" 5Others 5 @120eQ齎圢歔t^g錯<5????????????? 4130 Nx枅N歔/n05 ??????????  5 Date of entry 5 Port of entry 5 4140辬(W圢歔g摃05 ?????????? *150 T4O€n0 g!q&5???????? g5??? 5 Intended length of stay 5 Accompanying persons, if any 5Yes 5No 5 8160鹓魐褟n0鶴eQ齎tk:5???????????????K0? 5time(s) 5The latest entry from 5 Day to 5'l180痳j?t1uh0Y0?鍽R?譙Q0_0S0h0n0 g!q 錯,g齎Yk0J0Q0??n0?+T€00 h5???????????????????????   #%Criminal record (in Japan / overseas) 5,wQSO剉匭筟(5 ?????????  5  5!q 5?Yes 5  ( Detail: 5)  5/ 5 No 5n190惢S7_6R萐o0鶴齎}T銷k0??鶴齎n0 g!qj5???????????????????????????   , Departure by deportation /departure order 5@ N奼00 g0?x悶bW0_04XT <5????????????? 轛pe5????6魐褟n0悇恡k25 ??????????? 2 (Fill in the followings when the answer is "Yes") 5#The latest departure by deportation 5200(W錯獕蟚6r?蚹?M憊P€?P[?DQ_蒠筜j0i0 蔛s0 TE\€5 ##???????????????????????????????????  e Family in Japan (Father, Mother, Spouse, Son, Daughter, Brother, Sister or others) or co-residents 5 殅0膅5??? l0T5???(ut^g錯$5???????4齎0M|?0W0遅05???????( TE\圢歔$5???????6銻賀HQ?恌[HQ25 ??????????? (WYu???ju鱏 5? yr%R8lOO€<f鴉ju鱏 5? Relationship 5Name 5Date of birth 5Nationality/Region 5(Intended to reside with applicant or not 5Place of employment/school 5Residence card number 5-Special Permanent Resident Certificate number 5o0D0?D0D0H0 5  5Yes / No 5o0D0?D0D0H0 5Yes / No 5;  5`20k0d0D0f0o0  kL0N硩Y0?4XTo0%R}k0奺QW0f0鹠豊Y0?S0h000j0J0, 0x頞0  0€b齹焄0k0翺?3u藠n04XTo0 N亯g0Y00 Regarding item 20, if there is not enough space in the given columns to write in all of your family in Japan, fill in and attach a separate sheet. In addition, take note that you are not required to fill in item 20 for applications pertaining to  Trainee /  Technical Intern Training .A511?????????????????????????????????????????????????   &+-"1$3(6+9.;o鑜  蠄b椔Sgqn0 N 3u藠k0臺亯j0鴉^槖0\ObW0f0 NU0D000Note : Please fill in forms required for application. (See notes on reverse side.)~5 ???????????????????????????????  303u藠篘I{\Ob(uK0? @b^\_jI{\Ob(uI{K0?o0 eQ齎顅剉k0揰c0f0 !kn0豬_?O(uW0f0O0`0U0D00544????????????????????????????????????????????????????$(!+%-'1*,eQ齎顅剉00Purpose of entry/(5 ????????? 婳00Example/5??,O(uY0?3u藠鴉00Type of form% (5 ?????????<3u藠篘I{\Ob(u85??????????????  N@b^\_jI{\Ob(uI{J5?????????????????! 'Yf[I{k0J0D0f0貧n0\€晞vj0齹汻? gY0?篘Pgh0W0f0xvz xvzn0c\5??????,'Yf[Ye坈(5 ?????????萐o0Ye瞼k0揰婲Y0?S0h0; `'Yf[I{k0J0Q0?xvzn0c\萐o0Ye瞼I{\5???????????????????????  CActivities for research, research guidance or education at collegest-Nf[!h 貧I{f[!hI{k0J0Q0?瀶f[Ye瞼I{p5??????????????????????????? <-Nf[!hn0瀶f[Ye+^85?????????????? ;V蜸eQ?4OF0競S Nn0;m誖00Activities for the arts that provide an incomeR5?????????????????????  0\O騠禰 橯w禰00Composer, Photographer ,5 ???????????"蜸eQ?4O?j0D0f[S堺0競S Nn0;m誖萐o0錯,gyr gn0噀S?€b競n0xvz?頞梍5 ..??????????????????????????????????????????????   #&)46僑 詆S悞0頞梍W0?F0h0Y0?€05 ??????????pY齎n0梉Ye鉜SOK0?>mc怳0?f0L團0^Ye;m誖< l5????????????????????????????  .鳶Ye Ye+^*5 ??????????vY齎n01XS恄jh0n0QY}k0鶺e0O01XS Nn0;m誖r5????????????????????????????   6癳^€€ 1XS惈0????25 ???????????錯,gk0B0?婲mi@bk0g摃?歔?f0鈳銻W0f0xvz;m誖k0揰婲Y0?S0h05???? "Y菍鹼Omin0xvz€5???????"P錯,gk0B0?婲mi@bk0g摃?歔?f0鈳銻W0f0貧n0\€晞vj0齹汻? gY0?篘PgL5??????????????????   @Y菍鹼Omin0袡(W酺<5???????????????? "錯,gk0B0?婲mi@bk0g摃?歔?f0鈳銻W0f0\€晞v€bS圛{?臺亯h0Y0?mi賀k05 &&??????????????????????????????????????  "%貧n0\€晞vj0齹汻? gY0?篘Pgh0W0f0婲min0L}禪萐o0tk0揰婲Y0?S0h0(; 5 %%?????????????????????????????????????  !>Omin0>yw  諷鄛y_ 钀w President, director , division head of a company%(5????  @婲min0L}禪萐o0t<5????????????? 7貧n0\€晞vj0齹汻? gY0?篘Pgh0W0f0xvz xvzn0c\萐o0Ye瞼k0 揰婲Y0?S0h0k0r奡_Y0?4XT?d朞00 ; 5 ..??????????????????????????????????????????????  ! %))-,0V?e淾翺_j Omin0xvz€R5?????????????????????  nQY}k0鶺e0M0蜸eQ?4OF0xvz?L團0;m誖j5???????????????????????????  J貧n0\€晞vj0齹汻? gY0?篘Pgh0W0f0陙6q褃f[萐o0篘噀褃f[n0R螒n0\€晞v €bS埲So0鍂X嫆0臺亯h0Y0?mi賀k0揰婲Y0?S0h0k0r奡_Y0?4XT?d朞00 ; 533??????????????????????????????????????????????????? $&(+"0&3*<.@1C._j癶錧f[I{n0€bS€ ???????mi賀揰婲€*5 ??????????C陙6q褃f[鍌W0O0o0篘噀褃f[n0R螒n0\€晞v€bS堝俉0O0o0鍂X嫆0臺亯h0Y0?mi賀萐o0Y齎n0噀Sk0鶺鋠? gY0?`€I{?臺亯h0Y0?mi賀k0揰婲Y0?S0h05FF?????????????????????????????????????????????????????????????????????? #!'#)%-(0+3.5183:5>:B=eP焣魙W0_0€b齹?亯Y0?mi賀k0揰婲Y0?S0h0 Activities to engage in services which require skills belonging to special fieldsL5?????????????????? 9JY齎檈tn0繆t+^ ????c\€ Foreign cuisine chef, Sport's instructorF5??????????????????yr歔n0xvz;m誖 xvz婲mi;m誖 臽1X鍽t;m誖5 &&??????????????????????????????????????   "Jc歔U0?_0_jn0xvz€?臽1X鍽t€bS€F5?????????????????? LkKb ???00Singer, Model5???*€b齹焄00Technical intern training&5????????.€b齹焄u00Technical intern trainee*5 ??????????蒖f[00 Study5???? "Yuf[u00Student5???????x頞5?????h焄賀x頞?L垙0j0D0x頞u lQ剉x頞?d5??????????????????????????? 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