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在留期間更新許可申請書 APPLICATION FOR …

For applicant, part1 Ministry of Justice,Government of Japan To the Director General ofRegional Immigration Bureau1 2 Nationality/RegionDate of birthDayFamily nameGiven name3 Name 4 5 6 SexMale/FemalePlace of birthMarital status7 8 OccupationHome town/city9 Address in Japan Telephone phone (1) (2) Passport NumberDate of expirationDay11 Status of residencePeriod of stay Date of expirationDay12 Residence card number13 Desired length of extension ( It may not be as desired after examination.)

申請人等作成用 2 P (「留学」) 在留期間更新・在留資格変更用 For applicant, part 2 P ("Student") For extension or change of status

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