by Supporting Each Other with Care
We will grant the "Year-End Mutual Support Encouragement Fund" through citizens' donations sothat those in need of support due to economic hardship can celebrate the New Year's holiday in theirfamiliar areas.
If you are interested, please check the conditions below to see if you are eligible or not before applying.
■Requisition Criteria (Households Eligible to Apply)Households residing in Higashiomi city with gross household income of the previous fiscal year
generally below the following thresholds are eligible for the grant. Gross household income includes
salary, business income(self-employment etc.) pension income(national pension, basic old-age
pension, disability pension, survivor’s pension, etc), child support allowance, etc.
Number of persons
1-person
2-person
3-person
4-person
5-personHouseholdHouseholdHouseholdHouseholdHouseholdin the householdStandard Amount¥1,030,000¥1,510,000 ¥1,990,000 ¥2,470,000 ¥2,950,000(Total revenues in
the previous fiscal
or lessor lessor lessor lessor lessyear）※¥480,000 will be added to the base amount for each additional family member.
※All persons living together are considered as one household. Even if the households are separated,
they are considered as one household if they share the same livelihood.
(Households receiving public assistance and those not living at home due to long-term
hospitalization or residential care are not eligible.)
Please fill out the application form and submit it to a local
commissioned welfare volunteer, child welfare volunteer, or theGeneral Affairs Division of the Council of Social Welfare (CSW), or
their respective offices. Application forms are available at theCSW(General Affairs Division and offices), City Hall, public
facilities (libraries, community centers, etc.), and the homes of local
commissioned welfare volunteers and child welfare volunteers.
(Application forms can also be downloaded from the CSW's website.)■Documents to Be Attached (Documents that can verify gross household income) Please attach
to the Application
to the back of the application form.
Copy of taxation (income) certificate, pension transfer notice,
withholding tax certificate, child support allowance notice, etc.
(Please attach to the back of the application form.)
If you are a sole proprietorship, please submit your previous year's tax■How to Apply

return in addition.(copy of Table1 and 2, statement of earnings andexpenses )■Application Deadline■Aid Decision■Aid Method■Handling of PersonalInformation■Contact Us

October 31, 2024 (Thursday)
The Community Chest Grant Project Review Committee will review
and decide on the grant.
※The amount of the grant will be determined based on the actual
amount of donations collected.
Households that are determined to be aided will receive theencouragement fund through local welfare volunteers and childwelfare volunteers.
Personal information obtained through this project will be provided
to local community welfare volunteers and child welfare volunteers.
It will not be used for any purpose other than this and projects
implemented by the CSW.

General Affairs Division, the Council of Social Welfare(CSW)
Phone: 0748-20-0502 IP: 0505-802-9070

This project is funded by the donations from the year-end mutual support fund.

REIWA6 2024 Year-End Mutual Support Encouragement Fund Application Form

Higashiomi City Council of Social Welfare
PresidentMs. Fusa Otsuka

I would like to apply for the Year-End Mutual Support Encouragement Fund as follows.
If you wish to apply for the year-end donor incentive grant, you must agree to the use of your personal
information in the application process, so please check the box below, fill in the required information, andsubmit your application.October 3, 2024 ☑ I agree to the use of my personal information below and apply forthe year-end donor incentive fund.

Date of Application: October 3, 2024

《APPLICANT》
Name in Hiragana

しゃきょう

Name

社協

はなこ (Shakyou Hanako)
seal

September 1, 1976

Date of BirthAddress(Shakyou Hanako)

花子〒 527－○○○○Higashi Omi-shi ○○-cho ○○-○○

Phone Number( 48years old )Apartment Name: △△Heights

Room 202(Cell phone)○○○-○○○-○○○○《Family members living together》※Please fill in all family members’ income
for the previous year including the applicant.
NameRela-age

tionship1

Shakyou Hanako

Applicant2

Shakyou Tarou

Son

48 years
old16 years
oldOccupation or
school name

Total revenues in the previous
fiscal year（①+②+③+④+⑤）

Part-time (Super XX)① ¥621,640 + ④ ¥430,280△△ High School① Part-time job ¥378,280

345
Total:¥1,422,200
Total revenues in the previous fiscal year includes all of the following ① through ⑤ below. Please enter
the total amount of all applicable income.
① Salaly income ② Business income(self-employment etc.) ③ Pension income(national pension,basic old-age pension, disability pension, survivor’s pension, etc) ④ Child support allowance, etc.
⑤ Others※The amount of income may be based on the current year’s income.
Total imcome of all household members《Documents to be attached to the application》

Please submit documents on the back of the application form that verify that the criteria have been met.
( Photocopies are acceptable.) (e.g., taxation (income) certificate, pension transfer notice, withholding tax
certificate, child support allowance notice, etc.) If you are a sole proprietorship, please submit your previous
year's tax return in addition.( copy of Table1 and 2, statement of earnings and expenses )《Requisition Criteria》※Please see the flyer for details.
Number of persons in
1-person
2-personthe household
HouseholdHouseholdStandard Amount¥1,030,000¥1,510,000(Total revenues in theor lessor less
previous fiscal year）

3-personHousehold4-personHousehold5-personHousehold¥1,990,000¥2,470,000¥2,950,000

or lessor lessor less《Related Persons Entry Form》(Special Note) Please describe the living conditions of the applicant
household to the best of your knowledge.
OpinionColumn The above applicant is deemed appropriate as a recipient of theencouragement fund.
commissioned welfare volunteer /commissioned child welfare volunteer

Name:

seal

seal ofacceptance bythe CSW

seal ofacceptance