【For Privately Financed International Students】

Check Sheet for Submission Documents
Description●This sheet is to make sure that you have filled in all the information when submitting your documents.
●Please follow the instructions for each item and check the required documents.
●The application reference date is April 1 for the first semester application and October 1 for the second semester application.
Application documents must be prepared based on the household situation as of the application reference date.

１. About household supporters and household members- Refer to the "Simplified Chart" to identify your household supporters and household members, and enter the number of people etc. on the "Household
Composition Confirmation Chart" below.
- The members listed on the Confirmation Cart are considered as your family members under this program. Please fill out the names, etc. of all family
members on the "[Form 1] Record of family" and prepare the necessary documents.

<Household Composition Confirmation Chart>
MemberHouseholdsupporter(s)Householdmember(s)(Date of landing permission) Number of people
day

Applicant(Spouse※(monthyeardaymonth

2. Documents that must be submitted by all applicants
3. Documents related to the income of applicants and household supporters
4. Documents related to applicants
5. Other necessary documents

1)

Required documentsyear)

Child(ren)

2. Documents that must be submitted by all applicants
5. Other necessary documents

Family member(s) living in Japan※ Since father/mother in Japan are household supporters, please include the number of persons in the "Spouse" column in the chart above and enter the date of landing permission.

【Reference】Simplified Chart
ApplicantPrivately FinancedInternational Student◎

Spouse◎Child(ren)○Father/Mother※Grand parents△

Siblings

NoteOnly family members residingin Japan should be listed.

△※Father/Mother in Japan are
Household supporters.

◎：Household supporter ○：Household member △：Household member if living together in Japan

2. Documents that must be submitted by all applicants (mandatory)
Please check the box for each document you complete.
CheckRequired Documents

Notes

□

Submission Documents Check Sheet

Please ensure that all documents are ready at the time of submission.

□[Form 1] Record of Family

Check the example and fill out correctly.

□[Form 2] Application Form

Check the example and fill out correctly.

Latest Income Taxation Certificate (Original)

Applicant and household supporter must submit this certification.
Submit a document which shows the following items:
Statement of whether the residence tax is imposed or not,Amount of each income from salary and non-salary income,Spousal deduction, Number of dependents and breakdown of deductions□*Note: Not required if you were not registered as a resident in Japanon January 1 of 2023 (at the first semester application)
or January 1 of 2024 (at the second semester application)□[Form 3] Income Report

Fill out all income related to applicant and household supporter.

□[Form 4] Budget Report Sheet (Original)

Fill out information about the person you live together with in Japan.
Signature of academic advisor is required.

□Photocopy of Residence Card

Copies must be submitted for the applicant and all family members living in Japan. Make
copies of both sides of the latest residence card.

□Photocopy of Apartment Lease Contract

The following items must be listed:
Property address, name of tenant, name of landlord, contract period,
monthly rent, name of occupant.
*Note: If you live in a dormitory, MIRAI CREA, or HU international house,a copy of the certificate is acceptable.)(Please turn over)Student
ID number3. Documents related to the income of applicants and household supporters
Questions
Do you (and/or your spouse) receive employment incomeof part-time job?

Check

If "Yes", submit the documents. (●:Required, 〇: One of the documents)

Required Documents

Issuer●Withholding Tax Certificate for the year 2023
□Yes

*If not available, submit pay stubs (copy) or bankbook (copy) for 2023
(Bankbook should be highlighted where the name, period, and amount are written.)Place of employment□

Yes●Withholding Tax Certificate for the year 2023

Place of employment

Did you (and/or your spouse) change jobs or start working afterJanuary 2 of the previous year and are you (and/or your spouse) still
employed at the same place of employment? (*Excluding part-time jobs)□Yes

Have you (and/or your spouse) changed employment status since
January 2 of the previous year? (*Excluding part-time jobs)□Yes

Have you (and/or your spouse) been working at the same place ofemployment since before January 1 of the previous year?
(*Excluding part-time jobs)●Withholding Tax Certificate for the year 2023
● [Form 5] Certificate of (estimated) salary payment (Original)●Withholding Tax Certificate for the year 2023
● [Form 6] Certificate of (planned) change of employment status (Original)

Place of employment

Place of employment●Record of payment of rewards, fees, etc. (If received)
Have you (and/or your spouse) ever received any non-salary
income* since before January 1 of the previous year andhave you filed a tax return?

○The first and second pages of the final tax return of 2023 and thestatement of earnings and expenses (or statement of blue return)□Yes(*non-salary income: income from business, agriculture,real estate, interest and dividend, and miscellaneous income)*Third table, if any, must be submitted.
*If "as per attached sheet" is indicated, a separate sheet must also be submitted.
*A stamped receipt (for electronic applications, the receipt number) is always required.

Tax Office/Local government○Front and back of the 2024 municipal tax declaration form anda statement of earnings and expenses*A stamped receipt (for electronic applications, the receipt number) is always required.

●Photocopy of notification of discontinuance of businessDid you (and/or your spouse) start a new self-employmentbusiness on or after January 2 of the previous year?

□Do you (and/or your spouse) receive a pension*?
(*pension: public pension, private pension, corporate pension)□Yes

Did you (and/or your spouse) leave your employment
on or after January 2 of the previous year?

□Yes

Yes

*A stamped receipt is always required.

● [Form 9] List of income amounts (Original)○Latest pension payment notice○Latest pension amount determination notice*Withholding Tax Certificates are not accepted.

Tax Office/Local government

Japan Pension Service,
Mutual-benefit association, orInsurance companies, etc.

●Something that shows the date of separation from employment(e.g.: Withholding tax certificate or Employee release form1 etc.）

Place of employment*Not required for applicant's part-time jobs.

Are you (and/or your spouse) receiving employment insurance
due to unemployment?

□Yes●Employment insurance beneficiary certificate (both sides), page 1-4

Do you (and/or your spouse) have financial income such as stocktransfer income, dividend income, etc.?

□Yes●Annual transaction report(Documents showing details regarding profit and loss)

Securities firm□

Yes

●Certificate stating name, the amount of money received
and the period of receipt-Do you (and/or your spouse) receive any financial assistancefrom others?

□Yes●Documents showing the amount and period of assistance(Bank book, etc.)-Are you (and/or your spouse) a fellow of the Japan Society
for the Promotion of Science (JSPS)?

□Yes・NEW SPRING・Next-Generation AI・Fellowship for Female Graduate Students□

Yes●Notification of decision or certificate of approval*Including prospective recipients

Do you (and/or your spouse) receive any scholarships?

□Yes●Documents showing the name of recipient, the amount and durationof scholarships (Notification, certificate, etc.)

Do you (and/or your spouse) receive any allowances and benefits?
(e.g.: child rearing allowance, injury and sickness allowance, workers' accident
compensation insurance benefits, childcare leave benefits etc.)

Are you (and/or your spouse) a fellow of any of the following
fellowships?

●Notice of JSPS research fellowship screening results*Including prospective recipients

4. Documents related to applicants
Check

Required Documents

UniversityCompanies,University, etc.

Issuer● [Form 7] Supervisor’s statement (Original)□Yes

・To be filled out by academic supervisor
・After exceeding the standard term of study, students may applyfor an exemption only for the first half year.

5. Other necessary documents

MOMIJI website

If "Yes", submit the documents. (●:Required, 〇: One of the documents)

QuestionsCheck

Do you share a room?

□Yes

Are any of your household members enrolled inhigh school or above?

□Yes

Do any of your household members have a disability?

□Yes

Are you a single-parent household?

□Yes

Required Documents●Residence card of the roommate●Student ID card or Certificate of enrollment (Original)*Not required for applicant●Physical disability certificate, Rehabilitation certificate etc.
*Proof documents with name, certificate number, name of disability,and level (grade) of disability〇One of the certificates that show widow(er) or single parent(Income taxation certificate, withholding tax certificate, or tax return)〇Family register (Original)
Do any of the items (A) through (E) listed on pages 2 and 3of the "Application Guide" apply to you?

Japan Society for thePromotion of Science

If "Yes", submit the documents. (●:Required, 〇: One of the documents)

Questions[For graduate students exceeding the standard term of study forthesis preparation]
Is this your first semester beyond the standard term of study?

Hello work (Public Employment
Security Office)□Yes● [Form 8] Declaration of sudden change in household finances

StudentID numberIssuer
Roommates
School enrolled in

City, ward, town orvillage office
City, ward, town orvillage office・Place ofemployment etc.
MOMIJI website

【For Privately Financed International Students】

ExampleCheck Sheet for Submission Documents
Description●This sheet is to make sure that you have filled in all the information when submitting your documents.
●Please follow the instructions for each item and check the required documents.
●The application reference date is April 1 for the first semester application and October 1 for the second semester application.
Application documents must be prepared based on the household situation as of the application reference date.

１. About household supporters and household members- Refer to the "Simplified Chart" to identify your household supporters and household members, and enter the number of people etc. on the "Household
Composition Confirmation Chart" below.
- The members listed on the Confirmation Cart are considered as your family members under this program. Please fill out the names, etc. of all familymembers on the "[Form 1] Record of family" and prepare the necessary documents.

<Household Composition Confirmation Chart>
MemberHouseholdsupporter(s)Householdmember(s)(Date of landing permission) Number of peopledaymonthyear

Applicant( 28 Sep. 2023 )Spouse※( 20 Dec. 2022 )

day

month

2. Documents that must be submitted by all applicants
3. Documents related to the income of applicants and household supporters
4. Documents related to applicants
5. Other necessary documents

1year

1Child(ren)3

Family member(s) living in Japan0

Required documents

2. Documents that must be submitted by all applicants
5. Other necessary documents※ Since father/mother in Japan are household supporters, please include the number of persons in the "Spouse" column in the chart above and enter the date of landing permission.

【Reference】Simplified Chart
ApplicantPrivately FinancedInternational Student◎

Spouse◎Child(ren)○Father/Mother※

Grand parents△Siblings

Note
Only family members residing
in Japan should be listed.

△※Father/Mother in Japan areHousehold supporters.

◎：Household supporter ○：Household member △：Household member if living together in Japan2. Documents that must be submitted by all applicants (mandatory)
Please check the box for each document you complete.
CheckRequired Documents

Notes

☑

Submission Documents Check Sheet

Please ensure that all documents are ready at the time of submission.

☑

[Form 1] Record of Family

Check the example and fill out correctly.

☑

[Form 2] Application Form

Check the example and fill out correctly.

Latest Income Taxation Certificate (Original)

Applicant and household supporter must submit this certification.
Submit a document which shows the following items:
Statement of whether the residence tax is imposed or not,Amount of each income from salary and non-salary income,Spousal deduction, Number of dependents and breakdown of deductions☑

*Note: Not required if you were not registered as a resident in Japanon January 1 of 2023 (at the first semester application)
or January 1 of 2024 (at the second semester application)☑

[Form 3] Income Report

Fill out all income related to applicant and household supporter.

☑

[Form 4] Budget Report Sheet (Original)

Fill out information about the person you live together with in Japan.
Signature of academic advisor is required.

☑

Photocopy of Residence Card

Copies must be submitted for the applicant and all family members living in Japan. Make
copies of both sides of the latest residence card.

☑

Photocopy of Apartment Lease Contract

The following items must be listed:
Property address, name of tenant, name of landlord, contract period,
monthly rent, name of occupant.
*Note: If you live in a dormitory, MIRAI CREA, or HU international house,a copy of the certificate is acceptable.)(Please turn over)StudentID number〇〇〇〇〇〇〇

3. Documents related to the income of applicants and household supporters
Questions
Do you (and/or your spouse) receive employment incomeof part-time job?

Check

If "Yes", submit the documents. (●:Required, 〇: One of the documents)

Required Documents

Issuer●Withholding Tax Certificate for the year 2023☑

Yes

*If not available, submit pay stubs (copy) or bankbook (copy) for 2023
(Bankbook should be highlighted where the name, period, and amount are written.)Place of employment□

Yes●Withholding Tax Certificate for the year 2023

Place of employment

Did you (and/or your spouse) change jobs or start working afterJanuary 2 of the previous year and are you (and/or your spouse) still
employed at the same place of employment? (*Excluding part-time jobs)□Yes

Have you (and/or your spouse) changed employment status since
January 2 of the previous year? (*Excluding part-time jobs)□Yes

Have you (and/or your spouse) been working at the same place of
employment since before January 1 of the previous year?
(*Excluding part-time jobs)●Withholding Tax Certificate for the year 2023
● [Form 5] Certificate of (estimated) salary payment (Original)●Withholding Tax Certificate for the year 2023
● [Form 6] Certificate of (planned) change of employment status (Original)

Place of employment

Place of employment●Record of payment of rewards, fees, etc. (If received)
Have you (and/or your spouse) ever received any non-salary
income* since before January 1 of the previous year andhave you filed a tax return?

○The first and second pages of the final tax return of 2023 and thestatement of earnings and expenses (or statement of blue return)□Yes*Third table, if any, must be submitted.
*If "as per attached sheet" is indicated, a separate sheet must also be submitted.
*A stamped receipt (for electronic applications, the receipt number) is always required.

(*non-salary income: income from business, agriculture,real estate, interest and dividend, and miscellaneous income)Tax Office/Local government○Front and back of the 2024 municipal tax declaration form anda statement of earnings and expenses*A stamped receipt (for electronic applications, the receipt number) is always required.

●Photocopy of notification of discontinuance of businessDid you (and/or your spouse) start a new self-employmentbusiness on or after January 2 of the previous year?

□Do you (and/or your spouse) receive a pension*?
(*pension: public pension, private pension, corporate pension)□

Yes

Did you (and/or your spouse) leave your employment
on or after January 2 of the previous year?

□Yes

Yes

*A stamped receipt is always required.

● [Form 9] List of income amounts (Original)○Latest pension payment notice

Tax Office/Local government

Japan Pension Service,
Mutual-benefit association, orInsurance companies, etc.

○Latest pension amount determination notice*Withholding Tax Certificates are not accepted.
●Something that shows the date of separation from employment(e.g.: Withholding tax certificate or Employee release form1 etc.）

Place of employment*Not required for applicant's part-time jobs.

Are you (and/or your spouse) receiving employment insurance
due to unemployment?

□Yes●Employment insurance beneficiary certificate (both sides), page 1-4

Do you (and/or your spouse) have financial income such as stocktransfer income, dividend income, etc.?

□Yes●Annual transaction report(Documents showing details regarding profit and loss)

Securities firm□

Yes●Certificate stating name, the amount of money received
and the period of receipt-

Do you (and/or your spouse) receive any financial assistancefrom others?

□Yes●Documents showing the amount and period of assistance(Bank book, etc.)-

Are you (and/or your spouse) a fellow of the Japan Society
for the Promotion of Science (JSPS)?

□Yes・NEW SPRING・Next-Generation AI
・Fellowship for Female Graduate Students□

Yes●Notification of decision or certificate of approval*Including prospective recipients

Do you (and/or your spouse) receive any scholarships?

□Yes●Documents showing the name of recipient, the amount and durationof scholarships (Notification, certificate, etc.)

Do you (and/or your spouse) receive any allowances and benefits?
(e.g.: child rearing allowance, injury and sickness allowance, workers' accident
compensation insurance benefits, childcare leave benefits etc.)

Are you (and/or your spouse) a fellow of any of the following
fellowships?

●Notice of JSPS research fellowship screening results*Including prospective recipients4. Documents related to applicants
CheckRequired Documents

UniversityCompanies,University, etc.

Issuer● [Form 7] Supervisor’s statement (Original)☑

Yes

・To be filled out by academic supervisor
・After exceeding the standard term of study, students may apply
for an exemption only for the first half year.

5. Other necessary documents

MOMIJI website

If "Yes", submit the documents. (●:Required, 〇: One of the documents)

QuestionsCheck

Do you share a room?

☑

Yes

Are any of your household members enrolled inhigh school or above?

□Yes

Do any of your household members have a disability?

□Yes

Are you a single-parent household?

□Yes

Required Documents

Issuer●Residence card of the roommateRoommates●Student ID card or Certificate of enrollment (Original)*Not required for applicant●Physical disability certificate, Rehabilitation certificate etc.
*Proof documents with name, certificate number, name of disability,
and level (grade) of disability〇One of the certificates that show widow(er) or single parent(Income taxation certificate, withholding tax certificate, or tax return)〇Family register (Original)
Do any of the items (A) through (E) listed on pages 2 and 3of the "Application Guide" apply to you?

Japan Society for thePromotion of Science

If "Yes", submit the documents. (●:Required, 〇: One of the documents)

Questions[For graduate students exceeding the standard term of study forthesis preparation]
Is this your first semester beyond the standard term of study?

Hello work (Public EmploymentSecurity Office)□Yes● [Form 8] Declaration of sudden change in household finances

StudentID number〇〇〇〇〇〇〇

School enrolled inCity, ward, town orvillage office
City, ward, town orvillage office・Place of
employment etc.
MOMIJI website