Japan Visa Application Form Page 2
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2*Partner’s profession/occupation (or that of parents, if the applicant is aminor):
_____________________________________________________________________________________________________
Guarantor or reference in Japan (Please provide details of the guarantor or the person to be visited in Japan)
03-5213-1733
Council of Local Authorities for International Relations (CLAIR)
Name _________________________________________________
Tel.
___________________________
Address _______________________________________________________________________________________
Sogo Hanzomon Building, 6th Fl. - JET Management Department, 1-7 Kojimachi, Chiyoda-ku, Tokyo, Japan 1020083
NA
Date of birth ______________________
Sex:
Male
Female
(Day)/(Month)/(Year)
Employer
Relationship to applicant __________________________________________________________________________
NA
Profession or occupation and position _______________________________________________________________
NA
Nationality and immigration status __________________________________________________________________
Inviter in Japan (Please write “same as above” if the inviting person and the guarantor are the same)
Same as above
Name _________________________________________________
Tel.
___________________________
Address _______________________________________________________________________________________
Date of birth ______________________
Sex:
Male
Female
(Day)/(Month)/(Year)
Relationship to applicant __________________________________________________________________________
Profession or occupation and position _______________________________________________________________
Nationality and immigration status __________________________________________________________________
*Remarks/Special circumstances, if any _____________________________________________________________________
Have you ever:
•
been convicted of a crime or offence in any country?
Yes
No
•
been sentenced to imprisonment for 1 year or more in any country?**
Yes
No
•
been deported or removed from Japan or any country for overstaying your visa or violating any law or regulation?
Yes
No
•
been convicted and sentenced for a drug offence in any country in violation of law concerning narcotics,
marijuana, opium, stimulants or psychotropic substances?**
Yes
No
•
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?
Yes
No
•
committed trafficking in persons or incited or aided another to commit such an offence?
Yes
No
**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.
“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.”
Date of application: _______________________
Signature of applicant __________________________________
(Day)/(Month)/(Year)
*It is not mandatory to complete these items.
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.
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