和 4 年 11 月 1 日〒380-0936
長野県長野市岡田 130-10
長野県中小企業会館１F
This page is a sample. Use this sample as a reference to fill out the

Nagano Taro 様

application form written in Japanese.

（10××××）■0

Social Welfare Corporation Naganokenshyakaifukushikyogikai
Notice of start of redemption of special loans for the new coronavirus
The redemption of the special welfare loan fund you borrowed on Y●M●D●.
Will start on Y●M●D●.
To start redemption, please read the following contents, select ➀~③, fill out the redemption
procedure notification form, and return it in the enclosed return envelope. (Fill out thenotification form while looking at the sample)
Redemption Amount and Redemption Plan (This notice is based on data as of October 21, Reiwa 4.)
Loan Code

KA10××××

Renter Name

Nagano Taro

Renter Name

Emergency Micro Funds (Kinkyu koguchi shikin)

Loan decision
date
Loan amount
Redemption
start date
Redemption
BalanceY●M●D●,\200,000
Y●M●D●\200,000

Reimbursement

Redemption period Y ● M●D●, ～Y ● M●D●Sum24every monthPlan\8,330 Last month \8,410

Direct debit

23rd of every month (the next business day if it is a Saturday, Sunday ordateholiday)

Inquiries
Social Welfare Corporation Naganokenshyakaifukushikyogikai Tokureikanrijimu center
TEL:026-217-5681 ／ FAX:026-217-5689〒380-0936 Nagano Prefecture Nagano City Nakagosho Okada 131-10 Naganoken
tyushyoigyokaikan 101

Notification of Reimbursement Procedure
貸付コード

≪差込≫

氏名

≪差込≫

Redemption Method
Items to check(➀~③Enclose any of them incircles)※The date on which the web registration procedure was completed
is stated.

①Request for account transfer on the Web

How to fill out If you selectrequestform D
Registration completion datethe bank transferYM※After filling out the deposit account transfer request form, each item ☑
☐Account holder verification② Account transfer request form

☐Press the financial institution registration seal

☐Confirmation of transfer bank name

☐Confirmation of branch name entry☐Account number entry confirmation☐Affix the financial notification seal

outside the column③ Payment by convenience store☐Lump sum redemption

payment slip* One of the ☑ items to☐Planned split redemption

be confirmed⇒

Entry Date

2022/12 / 10

Renter Name (Self-signed) Taro NaganoOther exemption applications and change notifications
item A(④~⑥Enclose any of them in circles)

item B④Other exemption applications*☐Application for exemption☐Disability exemption

Either ☑ item A or B⇒

from receiving welfare benefits

application☐The lessee died

☐The lessee disappeared

oldnew⑤Reporting of Death orDisappearance. Please selecteither ☑ item A or B and send
it with supporting documents.
⑥Changes to address, name,and others. ※* Please send a
copy of your certificate ofresidence or driver's license,etc. that shows the change.

Entry Date

2022/12 / 10

Renter Name (Self-signed)
Name of heir

Taro Nagano

contact ０９０‐××××‐××××
contact

2QuestionnaireWith the start of redemption, we will conduct the following questionnaire for the purpose of understanding your situation. Thankyou for your cooperation. Responses are processed statistically and are not published as information that can identify a specificindividual.* Please answer the current situation of the borrower. (Please check the relevant □.) ）
Age

□10～

□20～

□30～

□40～ □50～ □60～

Nationality□Japan□Non-Japan（□China□Viet Nam□70～□Brazil□80～□90～□Philippines□Thailand□Other（））□aloneHousehold Status□two or more➡

□spouse□spouse and children□you and your child

Family size（）□you and your parents□other（）Household Status②□elderly households□not an elderly household※elderly households: households belonging to elderly people aged 65 and over

Elderly people□households with disabilities□not a household with a disability※households of issuers of physical,

Household③
rehabilitation, and mental health certificatesLivelihood□oneself□other than myself（□my husband or wife□my child□parents□siblings□other）
Centrators
Employment Status□Working≫Industry（□agriculture/forestry/fishery□mining□construction□manufacturing industry □traffic/transportation□
electricity/gas/water services□teal estate□telecommunications □wholesale/ retail□tourism/ accommodation□finance/ insurance□food& beverage services□learning support business□medical treatment□welfare□living-related services□entertainment/event industry□
public duty□other service industry□other（≫employment status(□full-time employees□short-time employees□day laborer□contract employees□associate Employee))□part-time job□temporary employees□other ())□Self-employed /sole proprietorship
Industry（□agriculture/forestry/fishery□mining□construction□manufacturing industry □traffic・transportation□
electricity/gas/water services□teal estate□telecommunications □wholesale/ retail□tourism/ accommodation□finance/ insurance□food& beverage services□learning support business□medical treatment□welfare□living-related services
public duty□other service industry□entertainment/event industry□□other（))□Unemployed□other（）□Looking for（I'm working, but I'm looking for）

□Not looking

Job hunting status□ I use an employment security office.

□other（）Supported by□yes□noMaisapo
yotal
Monthly Incomeyour￥￥householdHousehold□Needy as when borrowing

Finances□It has been improving since the time of borrowing. □It has recovered to the same level as before CoronaProblems※□No income

Multiple answers
allowed□I am in more trouble than when I borrowed□Spending exceeds income□I can't decide on a job□Repayment of debts□Repayment of debtsDelinized taxes, utility bills, etc.□Delinquent in rent
□Illness or poor health□No food□Nothing in particular3１ Payment Methods
For payment procedures, please select one of the following ➀~③ redemption methods. Please repay bydirect debit as much as possible.

【Payment Methods】
・Deposit account transfer: We will debit your registered account on the 23rd of every month.
・We will send you a payment slip that you can pay at the convenience store.
Once you receive it, please pay at your nearest convenience store by the 23rd.

➀Deposit account transfer request via Internet Web
You can easily register your account transfer request on the Internet Web from your PC or smartphone,and you do not need to affix your account registration seal. If you are having trouble finding a designatedbank near you, or if you have lost the seal registered in your account or do not know which seal it is,please use the online account transfer request. After online registration, please check the enclosed "Noticeof Redemption Procedure" ➀ and fill in the registration completion date, put it in a return envelope, andreturn it.
・URL https://nsyakyo.g-sb.net/top_new/
・You can easily access it with a QR code that uses your smartphone's camera.

Scan the QR code with your smartphone to see thehomepage
The screen will switch. Please enter them in order.

sample②Notification by account transfer request form
Also accepted in the enclosed paper "Deposit Account Transfer Request Form"It is.
Please fill in the form according to the enclosed sample and affix your deposit account notification stamp.
Enclose the "Notification of Redemption Procedure" ② with circles, □ the confirmation items, and return itin a return envelope together with the "Account Transfer Request Form". Please. If you need a completed
copy, please make a copy.
If you think it is difficult to report by deposit account transfer, please read③.
③Lump-sum redemption and planned installment redemption using a payment slip for
convenience storesIf you want to redeem using the payment slip, check the "Notification of Redemption Procedure" ③,
Please choose ☑ either "lump sum repayment" or " Planned installment repayment" and return it in a
return envelope. After arriving at the Tokurei Kashituke kanri jimu center, we will confirm the designateddetails and send you a payment slip for convenience stores.

sample42 How to submit the selected repayment procedure
Please select ➀~③ on the enclosed redemption procedure notification form, fill in the date of entry andthe name of the borrower, and return it in a return envelope.(No stamps required)
The back of the "Notification of Reimbursement Procedure" is a questionnaire. Thank you for yourcooperation in filling in the form

If you select ➀ or ③, please return only the "Application for Redemption Procedure" in the return envelope.
.

If you select ②, please include both the "Redemption Procedure Notification Form" and the Deposit Account Transfer Request Form.

* The lower part of the Reimbursement Procedure Notification Form is "Exemption Application Request / Various Change Notification".
* Even if you intend to apply for exemption, please be sure to fill out the "Notification of Reimbursement Procedure".
(Excluding changes due to death or disappearance)

3Notes on redemption

・The direct debit date (debit date) is the 23rd of each month. If there is no converted amount in youraccount, it will not be credited from you.
・If payment cannot be confirmed on the day of the transfer, we will send you a transfer slip from the"Tokurei Kashituke Kanri Jimu Center", so please pay the shortfall.
・ If the application procedure has not been completed by the exchange starting date described in theguide, or if the application has not been completed even after the exchange starting date has passed, the"Tokurei Kashituke Kanri Jimu Center" will send you a transfer form.
Welfare Corporation Nganoken Syakaifukushikyougikai Tokurei kashitu kekanri jimu center
TEL:026-217-5681 ／ FAX:026-217-5689
LINE chatbot is also opened. If you register as a friend, you can answer simple questions to"NaganokenSyakaifukushikyougikai".

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