Page 1 of Application Form (Draft)
Here is a quick rundown of what you will need to fill out on the postal application. Details may change as this is a draft copy and the one you receive may be slightly different.
1. Date of application (申請日)
Fill out the application date according to the Japanese calendar (we are currently in year two of Reiwa, written as 令和 2).
2. Your local municipality (令和2年4月27日時点の住民票所在市区町村)
Fill out the local municipality you are living in as of April 27. This information should be on your Residence Card.
3. Head of household information (世帯主(申請・受給者) - Full name (氏名)
Fill out your name as it is exactly printed on your residence card. Make sure to add your stamp (inkan) over the 印 symbol and the Japanese pronunciation of your name (furigana) in the small white rectangle above.
4. Head of household information (世帯主(申請・受給者) - Birthday (生年月日)
Fill out your birthday according to the Japanese calendar. Circle the era (Meiji - 明治) (Taisho - 大正) (Showa - 昭和) (Heisei - 平成) you were born in followed by the year (年), month (月), and day (日). If you are not sure of the era and year of your birth according to the Japanese calendar, have a look at this conversion website to find out.
5. Head of household information (世帯主(申請・受給者) - Current Address (現住所)
Fill out your current address as it is exactly printed on your residence card. Underneath, write in a phone number that is contactable during the day (日中に連絡可能な電話番号).
6. Members in your household (給付対象者(下記の記載内容を御確認ください。 もし記載に誤りがあれば、朱書きで訂正してください))
Members in your household will already be printed on the form. If there are any corrections that need to be made, please do this with a red pen.
The relationship of each member will also be detailed as follows:
Head of household (世帯主)
At the bottom, the total amount (合計金額) of funds payable to the head of household is printed.
7. Checkboxes (特別定額給付金を希望されな い方につきましては、以下の チェック欄(□)に×印を御記 入ください。)
Mark the checkbox with an X next to the name of the individual who does not want to receive the ¥100,000.
8. Box A - Transfer funds to a bank account (A 指定の金融機関口座(申請・受給者又はその代理人の口座に限ります。)への振込を希望)
Mark this box with an X if you would like to have funds transferred to your bank account. Note: this is the only option available unless you have extenuating circumstances.
If you have automatic payments from your bank account for water and sewage bills, resident tax, and/or receiving child benefits, check the box underneath marked: この口座が当市区町村の水道料、地方税等の引落し又は払込みに現に使用している口座であって、申請・受給者の名義で
You will also need to mark the boxes as follows:
Water and sewage bills (水道料引落口座)
Resident tax (住民税等の引落口座)
Receiving child allowance (児童手当受給口座)
9. Bank account information (except for JP Postal account)
In the leftmost box, write the name of your bank and circle one of the following options:
1. Bank (銀行)
2. Deposit Bank (金庫)
3. Community Bank (信組)
4. JA Bank (信連)
5. Agricultural Cooperative (農協)
6. Fisheries Cooperative (漁協)
7. Marine Bank (信漁連)
In the next box, write in the branch name (支店名) and the branch code (支店コード). You will also need to circle one of the following options:
Main office (本店)
Branch office (支店)
Main office (本所)
Branch office (支所)
Branch office (出張所)
In the following box, circle the category (分類) of your bank account:
1. Normal account (普通)
2. Checking account (当座)
In the following box, write out your account number (口座番号) from left to right.
Finally, write out the name of the account holder (口座名義) with the furigana in the space above.
10. JP Postal Account Information (ゆうちょう銀行)
If you have a JP Postal Account, you will need to fill in this section.
Fill out your account number in your passbook under (通帳記号) and (通帳番号).
Finally, fill out the name of the account holder (口座名義) with the furigana pronunciation in the space above.
11. Box B (申請書を窓口で提出し、後日、給付（申請書の返送の必要はありません。)
Mark this box if you have extenuating circumstances and need to submit the application form in person at the local city hall, town hall, or ward office. You may be able to collect the money at a later date. You do not need to post the application form in this instance.
12. Application by proxy (代理申請（受給）を行う場合)
You will need to fill in this section if you want to have someone else apply on your behalf.
Fill out the following information:
Full name of proxy (代理人氏名)
Birthday of proxy (代理人生年月日)
Address of proxy (代理人住所)
Phone number of proxy contactable during the day (日中に連絡可能な電話番号)
Circle one of the following options:
Apply or request (申請・請求)
Receive payment (受給)
Apply or request and receive payment (申請・請求及び受給)
Finally, write your full name and the furigana pronunciation followed by your inkan seal above the 印 mark.
Page 2 of Application Form (Draft)
13. Photocopy of your ID (e.g. driving licence) (申請者本人確認書類 写し貼付け)
Attach a photocopy of your ID in this box.
14. Photocopy of your bank account information (e.g. on your passbook) (振込先金融機関口座確認書類 写し貼付け)
Attach a photocopy of the page in your passbook with all of the bank account information. This should be for the account in which you want to receive the fund.