Saitama Prefectural Council of Social Welfare Repayment and Exemption of COVID-19 Special Loan Section Special loans such as emergency small amount funds due to the impact of the COVID-19 pandemic Notice of Repayment Balance and Application for FY2024 Repayment Forgiveness for «資金名称» 【Notice of Repayment Balance of Special Loans for Emergency Small Amount Funds】 which We hereby inform you of the current repayment balance (as of the creation reference date) of «資金名義is currently in its repayment period, as shown below. Please note that the repayment balance may differ if any repayments have been made after the creation reference date. In addition, those who were subject to inhabitants tax in FY2023 can apply for repayment forgiveness in FY2024 if they meet the requirements. For details, please refer to the enclosed information booklet and submit the application form on the right.
outstanding amount to be repaid Documents sent this time (enclosed items) ① Notice of Repayment Balance and Application for FY2024 Repayment Forgiveness, and Application form for repayment forgiveness (this document) ② "Special loans for which repayment forgiveness will be applied in FY 2024" information booklet *Please see P.4 for instructions on how to fill out the application form. ③ Return envelope [For Applications and Inquiries] Saitama Prefectural Council of Social Welfare, Repayment and Exemption of COVID-19 Special Loan Section [Telephone Number] 050-2018-1839 [Reception Time] Weekdays 9:00 am to 5:00 pm https://www.fukushi-saitama.or.jp/site/problem_33.html l (Form 1-1) Application Form for Repayment Forgiveness for Special Loans for Comprehensive Support Fund For «資金名称»
* Prepare the documents and add a ☑ to the box and relationship to the head of the household) 2024 An original of the borrower's FY certificate of inhabitants tax exemption • Which states that the borrower is exempt from both the "per- capita" and "per-income" pertions of inhabitants tax household and relationship to the head of the household) Originals of the borrower’s and the head of household’s 2024 the certificate of inhabitants tax exemption * Which states that the borrower and the head of the household are exempt from both the "per-capita" and "per-income" portions of inhabitants tax To the Chair of the Saitama Prefectural Council of Social Welfare l agree to the following six items and hereby apply for an exemption. If repayment forgiveness is approved, I agree to my personal information being provided to a self-reliance support (1) consultation agency for the purpose of utilizing it in the performance of the organization's duties. I agree to my personal information being provided to third parties to the extent necessary for this program. (2)   l agree that the Saitama Prefectural Council of Social Welfare may query the National Council of Social Welfare, other prefectural councils of social velfate, municipal councils of social welfare, local governments, public employment security offices, self-reliance support consultation agencies, household financial improvement support organizations, and other related organizations to receive my personal information to the extent necessary for this program. Neither I nor any members of my hodsehold are members of an organized crime group. I agree that the Saitama 4) Prefectural Council of Social Welfare may request, as necessary, information from government and other public offices pertaining to my on my household members', membership in an organized crime group.(Organized crime group is defined in Article 2. Item 2 of the "Act on Prevention of Unjust Acts by Organized Crime Group Members," as "An organization that is likely to encourage its members (including members of the organization's constituent organizations) to engage in violent unlawful acts, etc. collectively or habitually.") (5) l agree that if repayment forgiveness is rejected as a result of the screening, the reason for the rejection will not be disclosed. (6) l have not changed the head of the household for the purpose of receiving repayment forgiveness. I also agree that the repayment forgiveness will be revoked if any of the information in this application is found to be false or if any of the requirements for repayment forgiveness are found to be not applicable after the decision for repayment forgiveness has been made. / * Write the date you filled out this form * Please sign your name exactly as it appears above. Borrower's Name (Signature) Borrower's Name(Signature)