（Form４）

Budget Report Sheet
How to fill out the form
① Fill in the average monthly living expenses by dividing the estimated amount for one year by 12 months (one year fromthe application reference date April 1 for the first semester and October 1 for the second semester).
*In principle, the estimated amount should be filled in based on your actual living conditions in Japan so far.
Students who have just arrived in Japan should fill in an estimated amount based on the premise that they will be able
to maintain that standard of living in Japan.
② Total income and expenses should be the same amount. (Please write 0 for items with no income or expenses.)③ Be sure to check the Application Guide for details on required documents, especially regarding the following examples;copies of receipts and bank books related to expenses such as utilities are not required, however, an apartment lease contract is required.)④ Be sure to check the "Detailed instructions on how to fill out the form" in the example.

Supervisor's Comments
I certify that the applicant is in financial hardship as declared below and that it is necessary to have this application approved in order tocontinue their studies.
【Request for supervisors】
Please be forewarned that even if the applicant has obtained the approval of their supervisor, if any inconsistent facts are found upon receiving the application forms, theapplicant may be asked to confirm and correct them.

Name of Supervisor（signature）

Date

Table to be filled in by applicant
Income（Monthly average）

Expenses（Monthly average）

44,650TuitionApplicant

JPY

FamilyJPY Education Fees （books / stationery / research）

Applicant

JPY

Housing Costs

JPY

FamilyJPY

Utilities（electricity / gas / water）

JPY

Applicant

JPY Communication Fees（telephone / internet）

JPY

FamilyJPY

Insurance（National Health / fire）

JPY

JSPS Research Fellowship

JPY

Transportation（bus / JR / gasoline）

JPY

Benefits and Allowances

JPY

Food Expenses

JPY

SalaryJPY
JPY

Scholarship

Fellowship(NEW SPRING/ Next-Generation AI / Female
Graduate Students in Science and Technology)

Money transferred / brought from outside JapanJPY Daily Necessities（clothing / beauty）

JPY

Withdrawal of Savings

JPY

Entertainment

JPY

Child Rearing Allowance

JPY

Child Education / Child Care

JPY

OthersJPY Others（Medical Care / Remittance / Savings etc.）

Total

JPY

JPY

Total

JPY

JPY

Official use

JPY

JPY

Official use

JPY

JPY

I hereby declare that the above statements are true and correct.
Student ID Number

JPY

Date
Name of Applicantyear

monthday（Form４）

ExampleBudget Report Sheet

Detailed instructions on how to fill out the form
<Salary>
If you have salary income, please calculate and fill in the monthly salary based on the amount paid on the withholding tax certificate for the last year.
If the withholding tax certificate is not available, please calculate and fill in the monthly salary based on the last year's pay stubs or bankbook.
(In that case, last year's pay stubs (copy) or bankbook (copy, with highlighted where the name, period, and amount are written) must be submitted .)Students who have just arrived in Japan should fill in an estimated amount for one year from the application reference date divided by 12.
<Scholarship・Fellowship・JSPS Research Fellowship>
Please calculate and fill in the average monthly amount you will receive for the year of application.
(Documents showing the amount and period of benefits must be submitted.)
Example: Applicant receives the NEW SPRING of 2,280,000 yen per year.
Spouse receives another scholarship of 300,000 yen for 6 months.
Reported Amount Applicant: 2,280,000 yen ÷ 12 = 190,000 yen Spouse: 300,000 yen ÷ 6 = 50,000 yen<Tuition>
Please state the regular amount without exemptions. (annual tuition 535,800 yen ÷ 12 months = 44,650 yen)
*The amount set for long-term students is different and should be corrected.
<Housing Costs>
If living with a roommate, please state the amount of rent you are responsible for. (Please submit a copy of your roommate's residence card.)<Daily Necessities>
Daily Necessities include toilet paper, detergent, garbage bags, and other items necessary for daily life, so please be sure to include thesein your calculations (excluding food expenses).
*Any false declaration will be dealt with strictly, including denial of exemption.

Table to be filled in by applicant
Income（Monthly average）

Expenses（Monthly average）

Applicant70,000JPY

44,650JPYFamily60,000JPY Education Fees （books / stationery / research）

50,000JPY

Applicant0JPY

Housing Costs

54,000JPYFamily50,000JPYUtilities（electricity / gas / water）

18,000JPY

Applicant190,000

JPY Communication Fees（telephone / internet）

15,000JPYFamily0

JPY

Insurance（National Health / fire）

10,000JPY

JSPS Research Fellowship

0

JPY

Transportation（bus / JR / gasoline）

6,000

JPY

Benefits and Allowances

10,000JPY

Food Expenses

56,000JPY

Money transferred / brought from outside Japan

30,000JPY Daily Necessities（clothing / beauty）

50,000JPY

Withdrawal of Savings

20,000JPYEntertainment

20,000JPY

Child Rearing Allowance

0

JPY

Child Education / Child Care

50,000JPY

Others

22,325JPY Others（Medical Care / Remittance / Savings etc.）

78,675

JPY

Total

452,325

JPY

452,325

JPY

SalaryScholarship

Fellowship(NEW SPRING/ Next-Generation AI / Female
Graduate Students in Science and Technology)

Tuition

Total

JPY

Official use

JPY

JPY

Official use

JPY

JPY

I hereby declare that the above statements are true and correct.
Student ID number

A123456

JPY

Date
Name of Applicant

2024

year

4monthHirodai Manabu

15day