日本国政府法務省 記入例 2016年10月1日現在 日本 …

1 For applicant, part1 Ministry of Justice,Government of Japan To the Director General ofRegional Immigration Bureau1 2 Nationality/RegionDate of birthDayFamily nameGiven name3 Name4 5 6 SexMale/FemalePlace of birthMarital status7 8 OccupationHome town/city9 Address in Japan Telephone phone (1) (2) PassportNumberDate 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.)14 Reason for extension15 Criminal record (in Japan / overseas) Yes( Detail:)/No16 Family in Japan(Father, Mother, Spouse, Son, Daughter, Brother, Sister or others) or co-residents Note : Please fill in forms required for application.

2 (See notes on reverse side.)Yes / No 16 , Regarding item 16, 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 addition, take note that you are not required to fill in item 16 for applications pertaining to Trainee or Technical Intern Training .Yes / No Yes / No 19XX.. LL0123456 Yes / No Yes / No Yes / No 9876543211 Special Permanent Resident Certificate number RelationshipNameDate of birthNationality/RegionResiding withapplicant or notPlace of employment/ schoolResidence card number 2 20xx x xYearMonth x-x-x 080-xxxx-xxxxXX12345678920xx x xYearMonth 10 YearMonthWASEDA TARO Married / Single APPLICATION FOR EXTENSION OF PERIOD OF STAY Pursuant to the provisions of Paragraph 2 of Article 21 of the Immigration Control and Refugee Recognition Act.

3 I hereby apply for extension of period of stay. 1995 10 Photo1. 2. 3. 4. 5. 3 6. 7. (2016 10 1 ) For applicant, part 2 P ("Student")For extension or change of status17 Place of study(1) Name of school(2) (3) AddressTelephone No. 18 19 (Fill in 18 and 19 in case of applying for a change of status, going to a higher school or changing your school)18 Total period of education (from elementary school to last institution of education)Years19 Education (last school or institution) or present school(1) Registered enrollmentGraduatedIn schoolTemporary absenceWithdrawal DoctorMasterBachelorJunior collegeCollege of technology Senior high schoolJunior high schoolElementary schoolOthers(2)

4 Name of the schoolYear20 Proof based on a Japanese Language Test Name of the test Attained level or score Organization and period to have received Japanese language education Organization Period from Others21 Japanese education history (Fill in the following when you study in high school) Organization and period to have received Japanese language education / received education by Japanese language Organization Period from22 Method of support to pay for expenses while in Japan(1) Method of support and an amount of support per month (average) SelfYenSupporter living abroadYen Supporter in JapanYenScholarshipYen OthersYen(2) Remittances from abroad or carrying cash Carrying from abroadYenRemittances from abroadYen Name of the individualDate and time ofOthersYencarrying cashcarrying cash(3) Supporter Name AddressTelephone No.

5 Occupation (place of employment)Telephone No. Annual incomeYen 82-1-444-5551000 1-1-182-1-222-33380,000 YearMonthtoYearMonth80,000 YearMonthtoYearMonth Date of graduation or expected graduationMonthJapanese language ability (Fill in the followings when you study at advanced vocational school or vocational school (except Japanese language))(3) 1-6-103-3207-145420 21 22 1 8 ( (1) For applicant, part 3 P ("Student")For extension or change of status(4) (1) Relationship with the applicant (Check one of the followings when your answer to the question 22(1) is supporter living abroad or Japan) HusbandWifeFatherMotherGrandfatherGrandm otherFoster fatherFoster mother Brother / SisterUncle / AuntEducational instituteFriend / Acquaintance Relative of friend / acquaintanceBusiness connection / Personnel of local enterprise Relative of business connection / personnel of local enterpriseOthers(5) (1) Organization which provide scholarship (Check one of the following when the answer to the question 22(1) is scholarship))

6 Foreign governmentJapanese governmentLocal government Others23 Are you engaging in activities other than those permitted under the status of residence previously granted? (1) (4) Fill in (1) to (4) when your answer is "Yes".(1) Type of work(2) Place of employmentTelephone No.(3) (4) Work time per weekHour(s)SalaryYenMonthlyDaily24 Plan after graduation Return to home countryEnter a school of higher education in Japan Find work in JapanOthers25 Actual guardian in Japan(Fill in the following if the applicant is to study at a junior high school or elementary school)(1) (2) NameRelationship with the applicant(3) Address Telephone Phone Legal representative (in case of legal representative)(1) (2) NameRelationship with the applicant(3) Address Telephone Phone No.

7 YearMonthDay Agent or other authorized person(1) (2) NameAddress(3) Telephone to which the agent belongs (in case of a relative, relationship with the applicant)In cases where descriptions have changed after filling in this application form up until submission of this application, the applicant(legal representative) must correct the part concerned and sign their name. I hereby declare that the statement given above is true and correct. Signature of the applicant (legal representative) / Date of filling in this form AttentionYes / No 03-1111-22221570,000 Public interest incorporated association /Public interest incorporated foundation25 26 Kim Jisoo2016101