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PCR検査問診票
陰性証明書及び検査結果通知書はメールでPDFデータにてお渡ししますので、再来不要です。
The certificate and inspection result notification will be provided in PDF data via email, so there is no need to come back.
证书和检查结果函将以PDF数据的形式通过电子邮件提供，所以不需要再来了。
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* Indicates required question
名前 (First name)
*
海外渡航用証明書を希望の方は、パスポートと同じ表記で記載してください
(Please use the same notation as on your passport.)
Your answer
苗字(Last name)
*
海外渡航用証明書を希望の方は、パスポートと同じ表記で記載してください
(Please use the same notation as on your passport.)
Your answer
生年月日(Birthday)
*
MM
/
DD
/
YYYY
性別(sex)
*
男性(male)
女性(female)
電話番号(Phone number)
*
Please fill in the number available in Japan
Your answer
メールアドレス(e-mail adress)
*
The certificate will be sent to this address in PDF format.
Your answer
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