Spreadsheet: c81f4ce0-6123-416c-9d70-172ddf4bac9b
Sheet: Sheet1

別記第六号の三様式（第六条の二関係） | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 | Unnamed: 17 | Unnamed: 18 | Unnamed: 19 | Unnamed: 20 | Unnamed: 21 | Unnamed: 22 | Unnamed: 23 | Unnamed: 24 | Unnamed: 25 | Unnamed: 26 | Unnamed: 27 | Unnamed: 28 | Unnamed: 29 | Unnamed: 30 | Unnamed: 31 | Unnamed: 32 | Unnamed: 33 | Unnamed: 34 | Unnamed: 35 | Unnamed: 36 | Unnamed: 37
 | 申請人等作成用 １ |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 日本国政府法務省
 | For applicant, part 1 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Ministry of Justice, Government of Japan
 |  |  |  |  |  |  |  | 在留資格認定証明書交付申請書
 |  |  |  |  |  |  |  | APPLICATION FOR CERTIFICATE OF ELIGIBILITY
 |  |  |  |  |  |  |  |  |  | 入国管理局長　　　殿
 | To the Director General of　　　　　　　　　Regional Immigration Bureau |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 写　真
 |  | 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。
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Photo
 |  | 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 Article 7, Paragraph 1, Item 2 of the said Act.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 40㎜×30㎜
1　国　籍 |  |  |  |  |  |  |  |  |  |  |  |  |  | 2　生年月日 |  |  |  |  |  |  |  | 年 |  |  |  | 月 |  |  |  | 日
 | Nationality |  |  |  |  |  |  |  |  |  |  |  |  |  | Date of birth |  |  |  |  |  |  | Year |  |  |  | Month |  |  |  | Day
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Family name |  |  |  |  |  |  | Given name
3　氏　名 |  |  | （漢字） |  |  |  |  |  |  |  |  |  |  |  |  |  | （英字）
Name in Chinese character |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Name in English
4　性　別 |  |  |  | 男 | ・ | 女 |  |  | 5　出生地 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 6　配偶者の有無 |  |  |  |  |  | 有・無
 | Sex |  |  | Male/Female |  |  |  |  |  | Place of birth |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Marital status |  |  |  |  | Married / Single
7　職　業 |  |  |  |  |  |  |  |  |  |  |  | 8　本国における居住地
 | Occupation |  |  |  |  |  |  |  |  |  |  |  | Home town/city
9　日本における連絡先
 | Address in Japan
 | 電話番号 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 携帯電話番号
 | Telephone No. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Cellular phone No.
10　旅券 |  |  |  | (1)番　号 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | (2)有効期限 |  |  |  |  |  |  |  |  |  | 年 |  |  | 月 |  |  | 日
 | Passport |  |  |  | Number |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date of expiration |  |  |  |  |  |  |  |  | Year |  |  | Month |  |  | Day
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
 |  | □ | Ｉ 「教授」・「教育」 |  |  |  |  |  |  | □ | Ｊ 「芸術」・「文化活動」 |  |  |  |  |  |  |  |  | □ | Ｋ 「宗教[NAME]
 |  |  | "Professor" / "Instructor" |  |  |  |  |  |  |  | "Artist" / "Cultural Activities" |  |  |  |  |  |  |  |  |  | "Religious Activities"
 |  | □ | Ｌ 「報道」・「研究（転勤）」・「企業内転勤」 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | □ | Ｍ 「[NAME]
 |  |  | "Journalist" / "Researcher (Transferee)"/ "Intra-company Transferee" |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | "Investor / Business Manager"
 |  | □ | Ｎ 「研究」・「技術」・「人文知識・国際業務」・「技能」・「特定活動（イ・ロ）[NAME] |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | □ | Ｏ 「興行」
 |  |  | "Researcher" / "Engineer" / "Specialist in Humanities / International Services" / "Skilled Labor" / "Designated Activities (a/b)" |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | "Entertainer"
 |  | □ | Y 「技能実習１号[NAME] |  |  |  |  |  |  |  |  |  |  |  |  | □ | Ｐ 「留学」 |  |  |  |  |  |  |  |  |  |  |  |  |  |  | □ | Ｑ 「研修」
 |  |  | "Technical Intern Training(i)" |  |  |  |  |  |  |  |  |  |  |  |  |  | "Student" |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | "Trainee"
 |  | □ | Ｒ 「家族滞在」・「特定活動(ハ)」・「特定活動（EPA家族）[NAME]
 |  |  | "Dependent" / "Designated Activities (c)" / "Dependent of EPA"
 |  | □ | Ｔ 「日本人の配偶者等」・「永住者の配偶者等」・「定住者[NAME] |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | □ | Ｕ 「[NAME]
 |  |  | "Spouse or Child of Japanese National" / "Spouse or Child of Permanent Resident" / "Long - Term Resident" |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Others
12　入国予定年月日 |  |  |  |  |  |  |  |  |  | 年 |  |  |  | 月 |  |  |  | 日 |  | 13　上陸予定港
 | Date of entry |  |  |  |  |  |  |  |  | Year |  |  |  | Month |  |  |  | Day |  |  | Port of entry
14　滞在予定期間 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 15　同伴者の有無 |  |  |  |  |  |  |  |  |  | 有・無
 | Intended length of stay |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Accompanying persons, if any |  |  |  |  |  |  |  |  | Yes / No
16　査証申請予定地
 | Intended place to apply for visa
17　過去の出入国歴 |  |  |  |  |  |  |  |  |  |  | 有・無
 | Past entry into / departure from Japan |  |  |  |  |  |  |  |  |  | Yes / No
 |  | （[NAME]） |  |  |  |  |  |  |  |  | (Fill in the followings when the answer is "Yes")
 |  | 回数 |  |  |  |  | 回 |  | 直近の出入国歴 |  |  |  |  |  |  |  |  | 年 |  |  | 月 |  |  | 日 | から |  |  |  |  |  | 年 |  |  | 月 |  |  | 日
 |  |  |  |  |  |  | time(s) |  | (The latest entry |  |  |  | from |  |  |  |  | Year |  |  | Month |  |  | Day | to |  |  |  |  |  | Year |  |  | Month |  |  | Day
18　犯罪を理由とする処分を受けたことの有無 [NAME]日本国外におけるものを含む。） |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Criminal record (in Japan / overseas)
 |  | 有 | （具体的内容 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | ） ・ 無
 |  | Yes | (Details |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | )  / | No
19　退去強制又は出国命令による出国の有無 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 有・無
 | Departure by deportation /dearture order |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes / No
 |  | （[NAME]） |  |  |  |  |  |  |  |  |  |  |  | 回数 |  |  |  |  | 回 |  | [NAME] |  |  |  |  |  |  |  |  |  | 年 |  |  | 月 |  |  | 日
 |  | (Fill in the followings when the answer is "Yes") |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | time(s) |  | The latest departure by deportation |  |  |  |  |  |  |  |  |  | Year |  |  | Month |  |  | Day
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, [NAME], Brother, Sister or others) or co-residents
[NAME] |  |  |  | 氏名 |  |  |  |  |  |  |  |  | 生年月日 |  |  |  | 国籍 |  |  |  | 同居予定 |  |  |  | 勤務先・通学先 |  |  |  |  |  |  |  | 外国人登録 証明書番号
Relationship |  |  |  | Name |  |  |  |  |  |  |  |  | Date of birth |  |  |  | Nationality |  |  |  | Intended to reside  with applicant or not |  |  |  | Place of employment/school |  |  |  |  |  |  |  | Alien registration  certificate number
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | はい・いいえ
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes / No
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | はい・いいえ
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes / No
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | はい・いいえ
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes / No
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | はい・いいえ
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes / No
（注） 裏面参照の上，申請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.)