在留資格認定証明書交付申請書APPLICATION FOR CERTIFICATE OF ELIGIBILITY格大　臣　殷法To the Minister of Justice Photo出入国管理及び難民認定法第7条の2の規定に基づき,次のとおり同法第7条第1項第2号に掲げる条件に適合している旨の証明書の交付を申請しますPursuant to the provisions of Article 7-2 of the Immigration Control and Refugee Recognition Act,  I hereby apply for the certificate showing eligibility for the conditions provided for in 7, Paragraph 1, Item 2 of the said Act. 40mm × 30mm 2生年月日Date of birth年Year 1994 Family name ・夜男5出生地Male  / Female Place of birth Accounting •無6配偶者の有無有Married /  Single Marital status 4性別Barcelona, Spain Sex 7硫茶8本国における居住地Carrer de Mallorca, 401, 08013 Barcelona Occupation Home town/city 9日本における連絡先学校法人山野学苑山野日本語学校、東京都渋谷区千駄ヶ谷3-10-6
日本海道立博物電話番号携帯電話番号03-5772-5112 080-3721-4994 Telephone No. Cellular phone No. #月日10 (2)有効期限(1)番 号D3558662005 7 2027 25 Year Month Passport Day Date of expiration Number 11入国目的(次のいずれか該当するものを選んでください。) Purpose of entry: check one of the followings □ K 「宗教」 □ L「報道」 □ I「教授」 "instructor" "Professor" "Artist" "Religious Activities" "Journalist" "Cultural Activities" □ L「研究(転動)」 □ M「経営・管理」 □ N「研究」 □ N「技術・人文知識・国際楽務」 □ L「企業内転勤」 "Engineer / Specialist in Humanites / International Services" "Intra-company Transferee" "Researcher (Transferee)" "Business Manager" N ・ ・ .
"Researcher"
 □ N「介護」 □ N「特定活動(本邦大学卒業者)」 □ N「技能」  □ N「特定活動（研究活動等）」 "Designated Activities ( Researcher or IT engineer of a designated org)" "Skilled Labor" "Designated Activities (Graduate from a university in Japan)" "Nursing Care" □   P 「留学」 □ Q「研修」 □ V「特定技能(1号)」 □ V「特定技能(2号)」 □  "Student" "Specified Skilled Worker ( i ) " "Trainee" "Specified Skilled Worker (  ii  ) "  "Entertainer" □ R「家族滞在」 □ Y「技能実習(1号)」 □ Y「技能実習(3号)」 □ Y「技能実習(2号)」 "Dependent" "Technical Intern Training ( i ) "Technical Intern Training (   ii   )" "Technical Intern Training (  iii  )" □ R「特定活動(本邦大卒者家族)」 □ R「特定活動(EPA家族)」 □ R「特定活動(研究活動等家族)」 "Designated Activities(Dependent of Gradutate from a university in Japan)" tion Activites (Depandent of Researcher or IT engineer of a designated orgin "Designated Activities(Dependent of EPA)" □  Τ ｢日本人の配偶者等」 □ T「定住者」 □ T「永住者の配偶者等」 "Long Term Resident" "Spouse or Child of Japanese National" "Spouse or Child of Permanent Resident" □ 「高度専門職(1号イ)」 □ Ｕ 「その他」 □ 「高度専門職(1号ハ)」 □ 「高度専門職(1号口)」
      "Highly Skilled Professional(i)(b)" "Highly Skilled Professional(i)(a)" "Highly Skilled Professional(i)(c)" Others年月日12入国予定年月日13 上陸予定港2020 10成田国際空港l Month Year Date of entry Day Port of entry 14  滞在予定期間15同伴者の有無有〈無〉 l. 6年Yes / No Intended length of stay Accompanying persons, if any 16査証申請予定地Barcelona, Spain Intended place to apply for visa 17過去の出入国歴〈有〉無Yes / No Past entry into / departure from Japan （上記で『有』を選択した場合） (Fill in the followings when the answer is "Yes") #月直近の出入国歴回数年-     8 Month 2014 2014 Year Year time(s) The latest entry from Day     to 18犯罪を理由とする処分を受けたことの有無（日本国外におけるものを含む。） Criminal record (in Japan / overseas)有（具体的内容Yes  ( Detail: 19 退去強制又は出国命令による出国の有無Departure by deportation /departure order Yes / No年回数直近の送還暦(上記です有]を選択した場合)同Year (Fill in the followings when the answer is "Yes") time(s)  The latest departure by deportation 20在日親族(父・母・配偶者・子・兄弟姉妹など)及び同居者Family in Japan (Father, Mother, Spouse, Son, Daughter, Brother, Sister or others) or co-residents有（「有」の場合は，以下の欄に在日親族及び同居者を記入してください。）・（無） Regarding item 3, if you possess your valid passport, please fill in your name as shoun in the passport. 0については、記載機が不足する場合は別帳に配入して溶付すること。なお,「研修」,「技能実習」に係る申請の場合は,「在日親族」のみ記載してください。 Regarding item 20, if there is not enough space in the given columns to write in all of your family in Japan, fil in and attach a secards sheet In addition, take note that you are only required to fill in your family members in Japan for applications pertaining to "Trainee" or "Technical Intern Training" (注)裏面参照の上,中靖に必要な書類を作成して下さい。  Note : Please fill in forms required for application. (See notes on reverse side.) For applicant, part 1市1国籍地域 Spain Nationality/Region月日9 9 Month Day 3氏名YAMANO　MARIA Name Given name月山8 30 Month Day単)    /    No月日Month Day申請人等作成用2     P  ( [留学] ) For applicant, part 2  P ("Student") 21  通学先 Place of study (1)名称学校法人山野学苑山野日本語学校Name of school (3)電話番号(2)所在地東京都渋谷区千駄ヶ谷3-10-6 03-5772-5112 Telephone No. Address 22 修学年数(小学校〜最終学歴) # 16 Years Total period of education (from elementary school to last institution of education) 23  最終学歴（又は在学中の学校）  Education (last school or institution) or present school □在学中□中退(1)在籍状況■卒業□休学中Graduated In school Temporary absence Withdrawal Registered enrollment ■大学口大学院(修士)口短期大学□大学院(博士) □専門学校College of technology Bachelor Junior college Doctor Master口高等学校□中学校口小学校□その他（ ) Senior high school Junior high school Elementary school Others (2)学校名(3)卒業又は卒業見込み年月田年2017 Name of the school  Madrid College Month Date of graduation or expected graduation Year 24日本語能力（専修学校又は各種学校において日本語教育以外の教育を受ける場合に記入） Japanese language ability (Fill in the followings when the applicant plans to study at advanced vocational school or vocational school (except Japanese language)) ■試験による証明Proof based on a Japanese language test (2)級又は点数(1)試験名Name of the test Attained level or score Japanese Language Proficiency Test (JLPT) Level 3 ■日本語教育を受けた教育機関及び期間 Organization and period to have received Japanese language education機関名Japanese School BARCELONA Organization月年#から期間:月　まで2019 Year 5 Month Year Month Present to Period from □その他Others 25日本語学習歴(高等学校において教育を受ける場合に記入) Japanese education history (Fill in the followings when the applicant plans to study in high school)日本語の教育又は日本語による教育を受けた教育機関及び期間Organization and period to have received Japanese language education / received education by Japanese language機関名Madrid College Organization日年年期間:月までから4 2014 Year 9 Month Year Month 2016 to Period from 26 滞在費の支弁方法等(生活費,学費及び家賃について記入すること。) ※複数選択可Method of support to pay for expenses while in Japan(fill in with regard to living expenses, tuition and rent) * multiple answers possible (1)支弁方法及び月平均支弁額 Method of support and an amount of support per month (average) ■在外経費支弁者負担田口本人負担85, 000 Self Yen Supporter living abroad口在日経費支弁者負担口奨学金田Supporter in Japan Scholarship Yen田Yen田Yen □その他Others田Yen (2)送金・携行等の別Remittances from abroad or carrying cash ■外国からの送金□外国からの携行田田85, 000 Carrying from abroad Yen Remittances from abroad Yen ）口その他田携行時期(携行者Name of the individual Date and time of Others Yen carrying cash carrying cash (3)経費支弁者(複数人いる場合は全てについて記入すること。) ※任意様式の別紙可Supporter(ff there is more than one, give information on all of the supporters )*another paper may be attached, which does not have to use a prescribed format. (1)氏名YAMANO　JORGE Name電話番号②住所Carrer de Mallorca, 401, 08013 Barcelona +34-93-4366115 Telephone No. Address電話番号+34-91-33333 Telephone No. ③職業（勤務先の名称） Occupation (place of employment) Banco  Santander (4)年収Annual income 4, 500, 000田Yen申請人等作成用3 For applicant, part 3  P ("Student") (4)申請人との関係(上記(1)で在外経費支弁者負担又は在日経費支弁者負担を選択した場合に記入) Relationship with the applicant (Check one of the followings when your answer to the question 26(1) is supporter living abroad or Japan)口茅□夫■父□母□祖父□祖母□養父□養母Husband Grandfather Wife Father Mother Grandmother Foster father Foster mother口受入教育機関□叔父(伯父) •叔母(伯母) □友人•知人□兄弟姉妹Brother / Sister Uncle / Aunt Friend / Acquaintance Educational institution □取引関係者・現地企業等職員口友人•知人の親族Business connection / Personnel of local enterprise Relative of friend / acquaintance □取引関係者・現地企業等職員の親族□その他( Relative of business connection / personnel of local enterprise Others (5)奨学金支給機関 (上記(1)で奨学金を選択した場合に記入)※複数選択可Organization which provide scholarship (Check one of the following when the answer to the question 26(1) is scholarship) * multiple answers possible口外国政府□日本国政府口地方公共団体Foreign government Japanese government Local government口公益社団法人又は公益財団法人（ □その他（ Public interest incorporated association / Others Public interest incorporated foundation 27卒業後の予定Plans after graduation □帰国■日本での進学Enter school of higher education in Japan Return to home country □その他( □日本での就職Find work in Japan Others 28本邦における申請人の監護人(通学先が中学校又は小学校の場合に記入) Actual guardian in Japan （Fill in the following if the applicant is to study at a junior high school or elementary school ) (2)本人との関係(1)氏名Name Relationship with the applicant (3)住所Address携帯電話番号Cellular Phone No. (2)本人との関係Relationship with the applicant電話番号Telephone No. 29 申請人,法定代理人,法第7条の2第2項に規定する代理人Applicant, legal representative or the authorized representative, prescribed in Paragraph 2 of Article 7-2. (1)氏名Name (3)住所Address携帯電話番号Cellular Phone No.電話番号Telephone No.以上の記載内容は事実と相違ありません。申請人(代理人)の署名／申請書作成年月日I hereby declare that the statement given above is true and correct. Signature of the applicant (representative) / Date of filling in this form年月日Year Month申請書作成後申請までに記載内容に変更が生じた場合，申請人（代理人）が変更箇所を訂正し，署名すること。生点In cases where descriptions have changed after filling in this application form up until submission of this application, the applicant Attention (representative) must correct the part concerned and sign their name. ※ 取次者 Agent or other authorized person (1)氏名(2)住所Name Address (3)所属機関等Organization to which the agent belongs竜話番号Telephone No. Day