在留期間更新許可申請書 APPLICATION FOR …

1 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.)

2 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 . (See notes on reverse side.) MonthPursuant to the provisions of Paragraph 2 of Article 21 of the Immigration Control and Refugee Recognition Act,I hereby apply for extension of period of stay. 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.

3 MonthYearRelationshipNameDate of birthPlace of employment/ schoolSpecial Permanent Resident Certificate number Residence card numberNationality/Region Yes / NoYes / No Residing withapplicant or not Yes / No APPLICATION FOR EXTENSION OF PERIOD OF STAYYear Year Married / SingleMonth Yes / NoYes / NoYes / No Photo40mm 30mm For applicant, part 2 P ("Student")For extension or change of status17 Place of study(1) Name of school(2) (3) AddressTelephone No.

4 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 schoo(1) Registered enrollmentGraduatedIn schoolTemporary absenceWithdrawal DoctorMasterBachelorJunior collegeCollege of technology Senior high schoolJunior high schoolOthers(2)

5 Name of the schoolYearDay20 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)

6 Remittances from abroad or carrying cash Carrying from abroadYenRemittances from abroadYen Name of the individualDate and time ofOthersYen carrying cashcarrying cash(3) Supporter Name AddressTelephone No. Occupation (place of employment)Telephone No. Annual incomeYenJapanese language ability (Fill in the followings when you study at advanced vocational school or vocational school (except Japanese language))to YearMonth YearMonthtoYear(3) Date of graduation or expected graduationMonth YearMonthMonth 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))

7 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) Foreign governmentJapanese governmentLocal government Others23 Are you engaging in activities other than those permitted under the status of residence previously granted?

8 (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 Legal representative (in case of legal representative)(1) (2) NameRelationship with the applicant(3) Address Telephone Phone No. 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) AttentionIn 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.

9 I hereby declare that the statement given above is true and correct. Public interest incorporated association /Public interest incorporated foundationSignature of the applicant (legal representative) / Date of filling in this form Yes / No