在留資格認定証明書交付申請(表紙)

APPLICATION FOR CERTIFICATE OF ELIGIBILITY

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Email *
1. 国籍・地域
(Nationality / Region)
*
2. 生年月日
(Date of birth)
*
MM
/
DD
/
YYYY
3. 氏名 (Name) *
4. 性別 (Sex) *
5. 出生地 (Place of birth) *
6. 配偶者の有無
(Marital status)
*
7. 職業(例:会社員、自営業、無職など)
 (Occupation)
*
8. 本国における居住地
(Home town / city)
*
9-1. 日本における連絡先
(Address in Japan)
9-2. 電話番号
(Telephone No.)
9-3. 携帯電話番号
(Cellular phone No.)
*
10-1. 旅券番号
(Passport Number) 
10-2. 旅券有効期限
(Passport Date of expiration)
MM
/
DD
/
YYYY
11. 入国目的
(Purpose entry. check one of the followings)
*
12. 入国予定年月日
(Date of entry)
MM
/
DD
/
YYYY
13. 上陸予定港
(Port of entry)
Clear selection
14. 滞在予定期間
(Intended length of stay)
15. 同伴者の有無
(
Accompanying persons, if any)
Clear selection
16. 査証申請予定地
(
Intended place to apply for visa)

17. 過去の出入国歴
(Past entry into / departure from Japan)

Clear selection
17-1. 回数 (time(s))
17-2. 直近の出入国歴
(
The latest entry from)
MM
/
DD
/
YYYY
17-2. 直近の出入国歴
(The latest entry to)
MM
/
DD
/
YYYY
18. 過去の在留資格認定証明書交付申請歴
(
Past history of applying for a certificate of eligibility)
Clear selection
18-1. 回数 (time(s)) 
(Fill in the followings when the answer is "Yes")
18-2. うち不交付となった回数 (time(s))
 (Of these applications, the number of times of non-issuance)
19. 犯罪を理由とする処分を受けたことの有無
 (Criminal record (in Japan / overseas)Including dispositions due to traffic violations, etc.)
*
20. 退去強制又は出国命令による出国の有無
(
Departure by deportation /departure order)
Clear selection
21. 在日親族

(父・母・配偶者・子・兄弟姉妹・祖父母・叔(伯)父・叔(伯)母など)及び同居者

(Family in Japan (father, mother, spouse, children, siblings, grandparents, uncle, aunt and others) and anyone you currently reside with)
Clear selection
A copy of your responses will be emailed to the address you provided.
Submit
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