The traveler must submit a copy of this “Written Pledge” to the airport quarantine office when entering
Japan.
(Updated on January 14, 2021)
Minister of Health, Labour and Welfare

Written pledge (Individual)（Name）
hereby declares the following items at the time ofreturn/re-entry/entry into Japan (hereinafter referred to as "entry"). I understand and accept that, if I violate
the pledge, my name (name and nationality in the case of a non-Japanese) and information that contributes tothe prevention of the spread of infection may be publicized by the relevant authorities. In addition to the above
if I am a non-Japanese, I understand and accept that I may be subject to revocation of status of residence anddeportation etc. under the provisions of the Immigration Control and Refugee Recognition Act in case of theviolation.
1. Personal information of the traveler.
Name (alphabet)

Age

Nationality Passport number

Departure Country / Region

Address (whereabouts if you live outside the address on your resident card)

2. Pledged items(a) I must take a Covid-19 testing conducted within 72 hours prior to departure time of the flight, and obtaina certificate certifying that the testing result is “negative” from a local medical institution, and there must
be no misrepresentation in the contents. Upon entry into Japan, I must submit the certificate or its copy
to the airport quarantine officer or the immigration officer.
(b) Upon entry into Japan, I must install the “LINE” application on my smartphone (If I use Business Track
or Residence Track, my smartphone or the smartphone used by receiving company/entity) and report myhealth condition through this application to the public health center that has jurisdiction over my homeor accommodation location every day for 14 days after entering Japan. Unless I use Business Track orResidence Track, if it is unavoidable that I am unable to report my health condition through the “LINE”application, I must agree to respond to the demands of the public health center etc. for following up on
my health condition every day for 14 days. In this case, if there is a specific follow-up method designatedby the public health center (e.g. daily reporting of health condition to an email address set up for reportingpurposes), I must follow it.
I install the “LINE” application on the following phone number:（－－） （Example: 090－××××－○○○○）(c) At the time of entry into Japan, I must install a Covid-19 Contact-Confirming Application designated by
the Ministry of Health, Labour and Welfare on my smartphone, and I must ensure that the application
remains active for 14 days after entry into Japan.
(d) Upon entry into Japan, I must begin retaining my location information through the map application
function of the smartphone, and retain this information for 14 days after entry into Japan. In addition, I
must respond to a demand of the public health center etc. to provide the location information.
(e) I do not use of public transportation (trains, buses, cabs/taxies, domestic airplanes, etc.) for 14 days afterentering Japan.
(f) I must stay at home or the accommodation for 14 days after arrival in Japan, and do not have contact withunspecified persons.
(g) In case that any symptoms within 14 days of entering Japan are observed, I must immediately contact the"Consultation Center for Covid-19" that has jurisdiction over my home or accommodation, tell themwhere I have stayed, and go to the designated medical institution to get medical treatment. In addition, ifI receive an instruction from the public health center etc., I must follow it.
(h) In case that I am tested positive within 14 days of entering Japan, I must cooperate with the investigation(active epidemiological investigation based on Article 15 of the Act on the Prevention of Infectious
Diseases and Medical Care for Patients with Infectious Diseases) by promptly presenting the location
data saved on my smartphone or other device after entering Japan to the public health center withjurisdiction. In addition, if I receive an instruction from the public health center etc., including thedesignation of a medical treatment place, I must follow it.
(i) The following infection prevention measures are taken:(1) Wear masks, (2) Thoroughly disinfect hands, (3) Avoid sharing small spaces and poorly ventilated
spaces with many people.