Address
Name Tel.
Date of birth
Relationship to applicant
Address
Name Tel.
Date of birth
Relationship to applicant
*Remarks/Special circumstances, if any
* It is not mandatory to complete these items.
Date of application
Signature of applicant
Guarantor or reference in Japan
(Please provide details of the guarantor or the person to be visited in Japan)
Profession or occupation and position
Nationality and immigration status
Inviter in Japan
(Please write 'same as above' if the inviting person and the guarantor are the same)
Nationality and immigration status
● been sentenced to imprisonment for 1 year or more in any country?**
● been deported or removed from Japan or any country for overstaying your visa or violating
any law or regulation?
Have you ever:
● been convicted and sentenced for a drug offence in any country in violation of law
concerning narcotics, marijuana, opium, stimulants or psychotropic substances?**
● engaged in prostitution, or in the intermediation or solicitation of a prostitute for other
persons, or in the provision of a place for prostitution, or any other activity directly
connected to prostitution?
● committed trafficking in persons or incited or aided another to commit such an offence?
** Please tick “Yes” if you have received any sentence, even if the sentence was suspended.
If you answered “Yes” to any of the above questions, please provide relevant details.
*Partner's profession/occupation (or that of parents, if applicant is a minor):
Yes No
Yes No
Yes No
● been convicted of a crime or offence in any country?
Yes No
Yes No
Any personal information gathered in this application as well as additional information submitted for the visa application
(hereinafter referred to as "Retained Personal Information”) will be handled appropriately in accordance with the Act on the
Protection of Personal Information Held by Administrative Organs (Act No. 58 of 2003, hereinafter, “the Act”). Retained Personal
Information will only be used for the purpose of processing the visa application and to the extent necessary for the purposes
stated in Article 8 of the Act.
“I hereby declare that the statement given above is true and correct. I understand that immigration status and period of stay to
be granted are decided by the Japanese immigration authorities upon my arrival. I understand that possession of a visa does not
entitle the bearer to enter Japan upon arrival at port of entry if he or she is found inadmissible.”
“I hereby consent to the provision of my personal information (by an accredited travel agent, within its capacity of representing
my visa application) to the Japanese embassy/consulate-general and (entrust the agent with) the payment of my visa fee to the
Japanese embassy/consulate-general, when such payment is necessary.”
(Day)/(Month)/(Year)
(Day)/(Month)/(Year)
Sex:
Sex:
Yes No
(Day)/(Month)/(Year)
Profession or occupation and position
Male
Female
Male Female
