Dependent Family Member
Removal Procedures

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Documents to be submitted [Please submit (1) to (3).](1) Notiﬁcation of Change of Health Insurance Dependents【Obtain from】

You can ﬁnd this on the Nissan Motor Health Insurance Society website.
Search for

5. Procedures for Removing a Family Member as a Dependent(2) Nissan Kenpo health insurance card
(3) Copy of your health insurance card from your place of employment or adocument that shows the date you enrolled in social insurance.

Documents to be submitted [Please submit (1) to (3).](1) Notiﬁcation of Change of Health Insurance Dependents【Obtain from】

You can ﬁnd this on the Nissan Motor Health Insurance Society website.
Search for⇒

Nissan-Kenpo ⇒ Go to Health Insurance Card, then
5. Procedures for Removing a Family Member as a Dependent(2) Nissan Kenpo health insurance card
(3) The following attached documents depending on the reason for removal
Reason for removal

Attached documents (copies are OK)

Excess income

No attached documents

Living separately

A document that shows the day you started living separately

Marriage

A document that shows the date of marriage or a document thatshows the day you started living separately

Divorce

A document that shows the date of divorce

Became an employment
insurance beneﬁciary

Proof of employment insurance beneﬁciary status (Ensure yousubmit a copy.)

Submission deadline

November 20, 2023 (Mon.)

Where to submit documents
Nissan Motor, Nissan Motor Kyushu

Family Member Details Oﬃce, HR SC,
Headquarters

Aﬃliated companies

Health insurance contact person at yourworkplace

About the Response Form and the required documents

For Stream Z

AnswerQ.1

Why is this survey being
conducted?

This survey is conducted under Article 50 of the Enforcement Regulations of the Health Insurance Act forthe purposes of maintaining fair certiﬁcation of dependents as well as ensuring the appropriateness of
insurance beneﬁts. This survey is therefore necessary to ensure all details have been provided to theSociety and to prevent deterioration of the Societyʼs ﬁnances owing to certiﬁcation as a dependent ofany person who should not be certiﬁed as a dependent.

Q.2

What if the required
documents are notsubmitted by the duedate?

Please note that if, without good reason, there is no response to repeated requests from the Society,and the Response Form or certiﬁcation documents are not submitted, the status of the dependent(s) will
be invalidated as of December 1, 2023, under Article 50, Paragraph 9 of the Enforcement Regulations of
the Health Insurance Act: "In the case of veriﬁcation or renewal, a policyholderʼs certiﬁcate that has notbeen veriﬁed or renewed shall be invalid." In such an event, please be aware that the bill for the healthinsurance portion of any expenses for medical attention received after the date of loss of dependent
status will be at own cost.

Q.3

What kind of company isOACS K.K.?

OACS K.K. specializes in projects and research related to the health insurance business, and has staﬀ
with expert knowledge and experience in dependent status surveys. OACS K.K. also has Privacy Markcertiﬁcation and has signed a contract with Nissan Motor Health Insurance Society concerning theprotection of personal information.

Q.4The policyholder has
already resigned/retired.
Do documents still need tobe submitted?

Please write "Policyholder resigned/retired in [month]" in the remarks ﬁeld in the Response Form andsubmit the Response Form only. (If the policyholder resigns/retires in or after December, he/she is stilla survey respondent, so please submit the documents.)

Q.5

Costs are incurred toobtain a residence
certiﬁcate. Does theSociety bear those costs?

The expenses and transport costs you incur to obtain certiﬁcation documents are all at own cost. We ask
for your understanding and cooperation for the purposes of fair dependent status veriﬁcation.

Q.6

Response Form(s) for mydependent familymember(s) was/were notenclosed. Why would thatbe?

Response Forms only for survey respondents are enclosed. Anyone whose name is not printed on theResponse Form does not need to complete the survey this time. Please read about survey respondents
on page 1.

Q.7

I donʼt have a certiﬁcateof income and withholding
tax for 2022. What should
I do?

Please either ask your workplace to reissue the certiﬁcate, or submit your 2023 income certiﬁcate orcopies of all your wages/salary statements for 2022.

Q.8

About the wages/salarystatements for the last
three months, the only
statement I can't ﬁnd is
the August one. Are theJuly and September
statements enough?

Please submit wages/salary statements for the three most recent months that you have (in this case
August is excluded, so they would be the June, July, and September statements).

Q.9

I donʼt receive paper
wages/salary statements.
What should I do?

Print out online statements conﬁrming the relevant months, gross wages/salary pay, commuting
allowance, etc. Note: If the respondent's name does not appear on the statement to be printed, pleasewrite the name in a blank space.

Q.10

I am a student and I work
part-time. Do I need tosubmit wages statements
or a certiﬁcate of income
and withholding tax, etc.?

Students aged 23 years or over (i.e., born on or before April 1, 2001) are required to submit acertiﬁcate. If you are a student aged 22 years or under (i.e., born on or after April 2, 2001) pleasesubmit a copy of your student card or certiﬁcate of student status.

Q.11

If I have wages income
from a part-time job, doyou base thedetermination on grosspay (before taxes) or net
pay (after taxes)?

The determination is based on gross pay (before taxes). The Society also treats commuting allowances
as income.

Q.12

How should I ﬁll in myincome for 2022 in theResponse Form?

If you have had any wages/salary or pension income during 2022, please enter the amount of grossincome before tax deductions. If you are self-employed or have other income, please enter the amountof sales.

Q.13

Is income fromself-employment
determined on the basisof the amount ofearnings?

Under the Health Insurance Act, income from self-employment is "total income less any ʻdirectlynecessary expensesʼ". For certiﬁcation as a dependent, the necessary expenses deducted from total
income are limited to the expenses without which the business would not be viable (i.e., "directlynecessary expenses"), unlike the necessary expenses accepted under the Income Tax Act. The amountof earnings as it appears on your tax return is not necessarily deemed to be income. Note: Please seethe Societyʼs website for information about the "directly necessary expenses" that the Society accepts.

Q.14

I have lost my most recent
Pension Bank Transfer(Revised) Notice. Whatshould I do?

If you have lost the notice, please ask the issuer (e.g., Japan Pension Service) to issue a Bank Transfer(Revised) Notice and submit it. (The same applies to disability pensions and survivor pensions.)

Q.15

Does income include
disability pension, publicoﬃcer pension, and survivor
pension? If I am receiving
one of these, whatdocuments should I submit?

Income includes all pensions. Please submit the most recent Pension Bank Transfer Notice for all thepensions you are receiving. However, this does not include personal pensions from life insurance policies.

Q.16

What is a remittancecertiﬁcate?

A "remittance certiﬁcate" is "a document conﬁrming the details of a remittance." Speciﬁcally, this could
be a copy of a receipt (bank transfer notice), a copy of a bankbook page showing a transaction between
a payer and payee, or similar. Please submit remittance certiﬁcates for the last three months (clearlyshowing who paid whom, when, and how much).

⇒Nissan-Kenpo ⇒ Go to Health Insurance Card, thenAbout the survey

Please do not put Dependent Family Member Removal Procedure
documents in the enclosed return envelope.
For Stream Y

11FAQs