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②

④

③

⑤ Bring your ID with you and present it at the municipal office counter.(ex. Resident Card, Passport, Insurance Card)

1

Address, Name (as appeared on your Residence Card), DOB

For whole family or partially?Number of copies?

Purpose: □ other (VISA update / extension)

①

②

③

④

A Suggestion: When you need a Certificate of Residence for your “VISA renewal”(Example: Setagaya, Tokyo)

Suggested items to add ✔：□ Relation (Household head, wife, child, …)□ History (Past moves, name changes, …)□ Nationality□ Residence Card Number□ My Number *□ Visa Information□ Date of Resident Registeration

(Date you became the resident)

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✔

Check the above 5 items

Check “Other” and describe the purpose

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* This example is a suggestion. Always follow the instruction that you receive from the Immigration Office.

Check □ here if it’s for yourself.Add your Phone Number.

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