When applying for a member of your family or relatives as your additional dependent【Conditions and Explanation】
This procedure is required when there is a change in dependents (as additional) due to family members who has been newly
accompanied, marriage, childbirth, divorce, spouse quitting work, etc.
In order to be certified, in principle, it is necessary to meet the following four conditions. You must apply attaching certificates(documents) that make sure below 4 conditions apply and he/she is necessary to be certified by the Health Insurance Organization.
Then the health insurance card for your dependent will be provided.
1. Supported mainly from the income of the insured person
2. Within the scope of those who can become dependents: The range of family members who can become dependents is determined
to be relatives within the third degree of kinship. In addition, the conditions differ depending on whether you live together orseparate.
3. Be under 75 years of age
4. Have a certificate of residence in Japan【Procedure】
Documents for submission

Notification of Change of Health Insurance Dependents(健康保険被扶養者異動届 Kenko Hoken Hifuyosha Ido Todoke)

Other required documents

Documents proving that you meet the criteria for recognition of dependents(please confirm below)

Eligible person

Employees who have a family change occurred recently

Deadline

Within 5 days in principle after the occurrence of the family change

SubmittoNML/

Lisa application : ( HR SC Kyuuyo）e-mail : lisa_kyuuyo@mail.nissan.co.jp

Nissan Motor Kyushu

Internal mail Ａ）HRSC Family Change application service

Other company

Health Insurance Counter in each related officeAttachment Details
When you have a dependent at thesame time as you join the company□ Certificate of residence ( 住 民 票 Jumin Hyo) with a relationship for all
members of the household□ Certificate of income (収入証明書 Shunyu Shomei Sho)
(Have income: Pay slips for the last three months, etc.)(No income: Tax exemption certificate, retirement certificate, etc.)□ Declaration of Dependent Status (扶養状況申告書 Fuyo Jokyo Sinkoku Sho)*in case of upper 18 years old□ National Pension No. 3 Notification Form (国民年金第三号届出書 Kokumin
Nenkin Daisango Dodokedesho)

When you get married□ Certificate of residence ( 住 民 票 Jumin Hyo) with a relationship for all
members of the household□ Certificate of income (収入証明書 Shunyu Shomei Sho)
(Have income: Pay slips for the last three months, etc.)(No income: Tax exemption certificate, retirement certificate, etc.)□ Certificate showing the date of marriage□ Declaration of Dependent Status (扶養状況申告書 Fuyo Jokyo Shinkoku Sho)
*In case of 18 years old and above□ Disqualification certification (資格喪失証明書 Shikaku Soshitsu Shomei Sho)
*In case of National Health Insurance or uninsured is not required□ National Pension No. 3 Notification Form (国民年金第三号届出書 Kokumin
Nenkin Daisango Todokede Sho)

When your spouse quits the job□ Certificate of residence ( 住 民 票 Jumin Hyo) with a relationship for all
members of the household□ Retirement certificate (退職証明書 Taishoku Shomei Sho) or disqualification
certificate (資格喪失証明書 Shikaku Soshitsu Shomei Sho)
□ Declaration of Dependent Status (扶養状況申告書 Fuyo Jokyo Shinkoku Sho)
*In case of 18 years old and above□ National Pension No. 3 Notification Form (国民年金第三号届出書 Kokumin
Nenkin Daisango Todokede Sho)

When your child was born

□ Certificate of residence ( 住 民 票 Jumin Hyo) with the relationship of all
members of the household, or a copy of the page with the mayor's seal columnof the maternal and child handbook (母子手帳 Boshi Techo)