To parents and guardians:
About the Procedures for Bank Account Transfers for School Fees (Request)
Here at the elementary and junior high schools in Minoh City, of the expenses required for yourchild during their school activities, we collect those expenses for school lunches/learning materials,etc., referred to as "school fees" by deducting them via bank account transfers (withdrawals). Pleaserefer to the items shown below and on the reverse side of this notice, and please use the distributed"Bank Account Transfer Request Form" to complete the procedures.

1. How to Complete Procedures(1) Applicable Financial Institutions•••

Senshu Ikeda Bank, Ltd., or Sumitomo Mitsui Banking Corporation
As long as you use either of the above financial institutions, you may select an account at any of theirbranches regardless of whether or not they are located in this city.
If you do not possess a savings account at the financial institutions listed above, we ask that you first visit abank teller at either bank to create a new account.

(2) Submitting a Bank Account Transfer Request Form••••Please fill out the required items and affix your registered bank seal to the bank account transfer request
form, and submit it to a bank teller at an applicable bank (please refer to the entry example on the reverse
side of this notice).
If you have a savings account at the financial institutions listed above, you may submit this form at any of
their branches.
You are required to submit 1 form for each individual child.
In addition to Minoh City municipal elementary and junior high schools, bank account transfer request forms
can also be obtained at the Minoh City Board of Education Secretariat, School Administration Center, aswell as the individual branches of Senshu Ikeda Bank located in the city of Minoh.

(3) Changing a Currently Registered Bank Account••Please submit a bank account transfer request form to the applicable financial institution to which you arechanging your account to. Due to bank processing procedures, it will take roughly 2 months for such changes
to withdrawal accounts to be applied. Although you will not be required to follow any procedures for your oldaccount, we ask that you do not cancel your old account until a withdrawal has successfully been made fromyour updated account.
If changes are made to the name of the account holder, you will be required to once again submit a bankaccount transfer request form. After you have completed the procedures to change the name of the accountholder at your financial institution, please submit a bank account transfer request form that lists the name of
the new account holder to a bank teller at your financial institution.

2. Bank Account Transfers for School Fees
(1) About Transfer Dates••••

As a basic rule, bank transfers shall be made on the 9th of every month between June and March of thefollowing year.
Your school will notify you of the schedule for bank transfers.
If a withdrawal cannot be made due to insufficient funds, a bank transfer will once again be attempted on
the 27th. For such cases, please make sure to deposit the required amount to your registered account by
the specified deadline.
If funds still cannot be withdrawn during the subsequent bank transfer, there may be cases where we collectthese fees by deducting them from your childcare allowance or financial assistance for school expenses(only applicable for recipients).

(2) About the Funds Being Transferred••These expenses will be used to cover school lunch fees, learning material fees, funds for school trips andexcursions, Japan Sport Council Disaster Mutual Aid premiums, and PTA membership dues, etc.
Your school will notify you on details, such as the individual expense items and their amounts.

<<Contact info>> Minoh City Board of Education Brighter Futures for Children Office
School Life Support Division, School Administration Center
Minoh City Hall Annex Bldg. 3rd Floor, counter #34, 4-6-1 Nishishoji, Minoh-shi
Phone no.: 072-724-6779 (direct line)

Minoh City Municipal School Fees

For MinohBank Account Transfer Request Form/Application Concerning Collection of School Lunch Fees, etc., for Childcare
Applicable financial institution
Mayor of Minoh City
Minoh City Superintendent

Addressed to:I hereby agree to pay Minoh City municipal school fees by having funds transferred from the following account, and after
verifying the contents of this agreement, I would like to submit this request as shown here.
In the event that non-payment of school fees is identified for the applicable student or a sibling living in the same household,in accordance with the provisions of Article 21 Paragraph 2 of the Childcare Allowance Act, I request that these expenses be
deducted from the amount of childcare allowance to be received from the mayor of Minoh City, and that they be allocatedtoward fulfilling said payment on the payment deadline.
Moreover, during the period where the applicable student is enrolled in a Minoh City municipal school, the contents of thisagreement shall remain in effect except for in cases where this application is rescinded or the contents of this application arechanged (related to Article 12 Paragraph 10 of the enforcement regulations of the Childcare Allowance Act).
*Please use a ballpoint pen to fill out the items enclosed in the thick-framed borders.

Student

Date of entry

Name of school

Furigana

Minoh City
Municipal

Name(year)

Date of birth(month)(year)(day)(month)(day)

Furigana
Applicant(Guardian/childcare
allowance
recipient)

Name
Postal code－

Seal

Address

Phone no.

（）Please also affix seal
to 2nd sheet－

Childcare allowances are disbursed with the purpose of promoting the healthy development of children. Toward this end, a system has been put in place
for the Childcare Allowance Act that allows school fees, such as for expenses for school goods and school lunches, etc., to be collected from suchchildcare allowances. In the event that non-payment occurs for school fees and where subsequent transferring of funds cannot be performed, payments forsuch school fees will be diverted from your childcare allowance, and we kindly ask for your understanding on this matter.
Financial institutioncode

Branch code
Bank

Financial
institution

Account type
Main branch
BranchSubbranch

Account no.
(Please align numbers to the right.)

Savings
accountRegistered bank seal

NameofaccountholderFurigana

Name
Please also affix seal to2nd sheet.

Applicable financial institutions (Must either be Senshu Ikeda Bank, Ltd., or Sumitomo Mitsui Banking Corporation.)― Agreement ―(Reception seal)

1 When an invoice has been sent to my bank, I ask that the bank transfer the amount of payment given in the invoice, etc., from myspecified account on the specified date of transfer without providing me with prior notification.

2 Regarding the procedure for withdrawing funds from my deposits and savings, notwithstanding the regulations regarding savings
accounts, as a request will not be submitted for the disbursement of checks or savings passbooks, nor shall one be submitted torequest for a withdrawal of savings, I ask that the bank process this transaction in accordance with its prescribed method of payment.

3 It will not be necessary to issue a receipt after funds have been transferred.
4 If the remaining balance in the specified account on the date of transfer is less than the amount given in the invoice, etc., I will have noFieldforMinohCityuseobjections even if the invoice is returned to sender without my notification.

5 I will have no objections even in cases where this bank account transfer agreement is cancelled without my notification in the event thatthe bank deems cancellation to be necessary.

6 In the event that I intend on cancelling this bank account transfer agreement, I shall notify my bank and the Minoh City Board ofEducation.

7

Verified byEntered byHandled by

I shall not cause any inconvenience for my bank even in the event that a dispute were to arise in relation to the handling of these bankaccount transfers.

①◎ Minoh City copy箕面市学校徴収金 預金口座振替依頼書
箕面市用
兼 児童手当にかかる学校給食費等の徴収等に関する申出書
Entry example
取扱金融機関箕 面 市 長箕面市教育長宛

私は、箕面市学校徴収金を下記預金口座から口座振替によって支払うことを了承し、約定を確認のうえ依頼します。
私は、児童手当法第21条第2項の規定に基づき、当該児童生徒、同一世帯のきょうだいにかかる学校徴収金に未納が生じた場合、その費用について、箕面市長から支給を受ける児童手当の額から、支払期日をもって支払に充てる旨を申し出ます。なお、本申出書
Please fill out the name of the school
Name/furigana/date
は、申出の撤回又は申出内容の変更を行わない限りにおいて、当該児童生徒が箕面市立学校に在籍している間、効力を有するもの
that the student is scheduled to enter.とします。（児童手当法施行規則第12条の10関係）
of birth of childIf the student is already enrolled in a
Date of entryschool, please write the name of thatschool.
記入日
●年
● 月
● 日
※ボールペンで太枠内を記入してください。
学 校 名児 童生 徒

箕面市立ミノオ

フリガナ
名●● Elementary
School/Junior High School

前

Minoh Hanako
●● 年

生年月日

ミノオ

フ リ ガ ナ
名
申込者
（保護者・児童手当受給者）〒● 月

562 － ●●●●所印

印

Minoh-shi, ●●●● ● chome ●● - ●● Room no. △△

電話番号

● 日

Please write the name of theguardian that is receiving
childcare allowances.

Minoh Jiro

前

住ジロウ

ハナコ

●●●

（）

●●●●－●●●●

２枚目も押印

児童手当は、子どもの健やかな成長に役立てられることを目的に給付されています。そのため、児童手当法では学用品費や給食費等の学校徴収金を児童手当から徴収できる仕組みがPlease also affix
Please leave a space between the first
設けられています。学校徴収金に未納が生じ、且つ再度の振替ができなかった場合は、本申出書に基づき、児童手当から学校徴収金の支払いに充てますので、ご理解いただきますようお
seal to 2nd sheet.
and last name.
願いいたします。

Please use 1 space for diacritic marks.
Please write one of the following.

Please circle the one that applies.
預金種目

金融機関コード

Senshu Ikeda Bank
Sumitomo Mitsui
Banking Corporation

金融機
関口座
名
義人

フリガナ名

前銀

Please align the account number
to the right.
口座番号

支店コード行ミ ノ オ●●●

本 店
支 店出張所（ 右詰めでご記入下さい ）0 1 2 3 4 5 6

普通シ ゛ ロ ウ

金融機関お届出印

印

Minoh Jiro

２枚目も押印

取扱金融機関 （ 池田泉州銀行 ・ 三井住友銀行 のいずれかに限る。）― 約定 ―
銀行に請求書が送付されたときは、貴行において、私に通知することなく、振替指定日に指定口座から納付書等の記載金額を振替納付してください。
2 預貯金の払出手続については、普通預金規定にかかわらず、小切手の振出又は預貯金通帳及び預貯金払戻請求書等の提出はいたしませんから、貴行所定の方法で処理してください。
3 振替後は、領収書の発行は不要です。
4 指定口座の残高が振替日において納付書等の金額に満たないときは、私に通知することなく、請求書を返却しても異議ありません。
5 この口座振替契約は、貴行が必要と認めた場合は、私に通知することなく解除されても異議ありません。
6 この口座振替契約を解除する場合には、私から貴行及び箕面市教育委員会へ通知します。
7 この口座振替の取り扱いについて、万一紛議が生じても貴行には迷惑をかけません。
1

Since yourfinancial institution
will use this toverify your account,please make surethe seal has been
affixed clearly.
Please also affix
入力 seal取扱者
to 2nd sheet.

（受付印）
箕面
市
使用欄
照合

Please take the 3 sheets (including duplicates), and submit
them to a bank teller at your financial institution.
①◎箕面市控