日本在留期间更新许可申请书.pdfVIP

別記第三十号二様式（第二十一条関係） 申請人等作成用 日本国政府法務省 For applicant, part1Ministry of Justice,Government of Japan 入国管理局長 殿 To the Director General ofRegional Immigration Bureau 1 国 籍地 域2 生年月日日 Nationality/RegionDate of birthDay Family nameGiven name 3 氏 名 Name 4 性 別男 女5 出生地6 配偶者有無 SexMale/FemalePlace of birthMarital status 7 職 業8 本国居住地 OccupationHome town/city 9 住居地 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)有効期限日 Passport NumberDate of expirationDay 11 現有在留資格在留期間 Status of residencePeriod of stay 在留期間満了日日 Date of expirationDay 12 在留番号 Residence card number 13 希望在留期間（審査結果希望期間場合。） Desired length of extension ( It may not be as desired after examination.) 14 更新理由 Reason for extension 15 犯罪理由処分受有無 （日本国外含。）Criminal record (in Japan / overseas) 有 （具体的内容） 無 Yes ( Detail:) / No 16 在日親族（父母配偶者子兄弟姉妹）及同居者 Family in Japan(Father, Mother, Spouse, Son, Daughter, Brother, Sister or others) or co-residents （注） 裏面参照上，申請必要書類作成下。 Note : Please fill in forms required for application. (See notes on reverse side.) Yes / No Yes / No Yes / No Yes / No 月年 有 無 Year 年 Married / Single Month 月 続 柄氏 名生年月日 国 籍地 域 同 居 特別永住者証明書番号 Residing with applicant or not 在留期間更新許可申請書 APPLICATION FOR EXTENSION OF PERIOD OF STAY Year Special Permanent Resident Certificate number 勤務先通学先 在留番号 Residence card number MonthYear 16，記載欄不足場合別紙記入添付。 ,研修，技能実習係申請場合記載不要。 Regarding item 16, if there is not enough space in the given columns to write in all of your family in Japan, fill in and attach a separate sheet. In addition, take note that you are not required to fill in item 16 for applications pertaining to “Trainee” or “Technical Intern Training”. Nationality/Region Yes / No Yes / No RelationshipNameDate of birthPlace of employment/ school 年 Month Pursuant to the provisions of Paragraph 2 of Article 21 of the Immigration Control and Refugee Recognition Act, I hereby apply for extension of period of stay. 月 出入国管理及難民認定法第条第項規定基，次在留期間更新申請。 写 真 Photo 申請人等作成用 （留学）在留期間更新在留資格変更用 For applicant, part 2 P (Student)For extension or change of status 17 通学先Place of study (1)名 称 Name of school (2)所在地(3)電話番号 AddressTelephone No. （18及19在留資格変更許可申請又進学若転学場合記入） (Fill in 18 and 19 in case of applying for a change of status, going to a higher school or changing your school) 18 修学年数 （小学校最終学歴）年 Total period of education (from elementary school to last institution of education)Years 19 最終学歴 （又在学中学校）Education (last school or institution) or present schoo (1)在籍状況 卒業 在学中 休学中 中退 Registered enrollmentGraduatedIn schoolTemporary absenceWithdrawal 大学院 （博士） 大学院 （修士） 大学 短期大学 専門学校 DoctorMasterBachelorJunior collegeCollege of technology 高等学校 中学校 小学校 他 （） Senior high schoolJunior high schoolElementary schoolOthers (2)学校名年 Name of the schoolYear 20 日本語能力 （専修学校又各種学校日本語教育以外教育受場合記入） 試験証明Proof based on a Japanese Language Test （）試験名Name of the test（）級又点数Attained level or score 日本語教育受教育機関及期間Organization and period to have received Japanese language education 機関名 Organization 期間： Periodfrom 他 Others 21 日本語学習歴 （高等学校教育受場合記入） Japanese education history (Fill in the following when you study in high school) 日本語教育又日本語教育受教育機関及期間 Organization and period to have received Japanese language education / received education by Japanese language 機関名 Organization 期間： Periodfrom 22 滞在費支弁方法等Method of support to pay for expenses while in Japan (1)支弁方法及月平均支弁額Method of support and an amount of support per month (average) 本人負担円 在外経費支弁者負担円 SelfYenSupporter living abroadYen 在日経費支弁者負担円 奨学金円 Supporter in JapanYenScholarshipYen 他円 OthersYen (2)送金携行等別Remittances from abroad or carrying cash 外国携行円 外国送金円 Carrying from abroadYenRemittances from abroadYen （携行者携行時期） 他円 Name of the individualDate and time ofOthersYen carrying cashcarrying cash (3)経費支弁者Supporter 氏 名 Name 住 所電話番号 AddressTelephone No. 職業 （勤務先名称）電話番号 Occupation (place of employment)Telephone No. 年 収円 Annual incomeYen (3)卒業又卒業見込年月月 Date of graduation or expected graduationMonth Japanese language ability (Fill in the followings when you study at advanced vocational school or vocational school (except Japanese language) 年月年月 YearMonthtoYearMonth 年月年月 YearMonthtoYearMonth 申請人等作成用 （留学）在留期間更新在留資格変更用 For applicant, part 3 P (Student)For extension or change of status (4)申請人関係 （上記(1)在外経費支弁者負担又在日経費支弁者負担選択場合記入） Relationship with the applicant (Check one of the followings when your answer to the question 22(1) is supporter living abroad or Japan) 夫 妻 父 母 祖父 祖母 養父 養母 HusbandWifeFatherMotherGrandfatherGrandmotherFoster fatherFoster mother 兄弟姉妹 叔父 （伯父）叔母（伯母） 受入教育機関 友人知人 Brother / SisterUncle / AuntEducational instituteFriend / Acquaintance 友人知人親族 取引関係者現地企業等職員 Relative of friend / acquaintanceBusiness connection / Personnel of local enterprise 取引関係者現地企業等職員親族 他 （） Relative of business connection / personnel of local enterpriseOthers (5)奨学金支給機関 （上記(1)奨学金選択場合記入） Organization which provide scholarship (Check one of the following when the answer to the question 22(1) is scholarship) 外国政府 日本国政府 地方公共団体 Foreign governmentJapanese governmentLocal government ） 他 （） Others 23 資格外活動有無 Are you engaging in activities other than those permitted under the status of residence previously granted? 有場合，(1)(4)各欄記入 Fill in (1) to (4) when your answer is Yes. (1)内 容 Type of work (2)勤務先名称電話番号 Place of employmentTelephone No. (3)週間稼働時間時間(4)報 酬円 （ 月額 日額 ） Work time per weekHour(s)SalaryYenMonthlyDaily 24 卒業後予定Plan after graduation 帰 国 日本進学 Return to home countryEnter a school of higher education in Japan 日本就職 他 （） Find work in JapanOthers 25 本邦申請人監護人（通学先中学校又小学校場合記入） Actual guardian in Japan(Fill in the following if the applicant is to study at a junior high school or elementary school) (1)氏 名(2)本人関係 NameRelationship with the applicant (3)住 所 Address 電話番号携帯電話番号 Telephone No.Cellular Phone No. 26 代理人（法定代理人申請場合記入）Legal representative (in case of legal representative) (1)氏 名(2)本人関係 NameRelationship with the applicant (3)住 所 Address 電話番号携帯電話番号 Telephone No.Cellular Phone No. 年月日 YearMonthDay 取次者Agent or other authorized person (1)氏 名(2)住 所 NameAddress (3)所属機関等（親族等，本人関係）電話番号 Telephone No. 公益社団法人又公益財団法人 （ Public interest incorporated association / Public interest incorporated foundation 有 無 Yes / No In cases where descriptions have changed after filling in this application form up until submission of this application, the applicant (legal representative) must correct the part concerned and sign their name. 以上記載内容事実相違。以上記載内容事実相違。I hereby declare that the statement given above is true and correct. Organization to which the agent belongs (in case of a relative, relationship with the applicant) 申請人（法定代理人）署名申請書作成年月日申請人（法定代理人）署名申請書作成年月日Signature of the applicant (legal representative) / Date of filling in this form 注 意注 意申請書作成後申請記載内容変更生場合，申請人（法定代理人）変更箇所訂正，署名。申請書作成後申請記載内容変更生場合，申請人（法定代理人）変更箇所訂正，署名。 Attention 所属機関等作成用 （留学）在留期間更新在留資格変更用 For organization, part 1 P (Student)For extension or change of status 1 在学中又入学予定外国人氏名及在留番号 Name and residence card number of the foreigner being at school or planning to enter the school (1)氏 名(2)在留番号 NameResidence card number 2 通学先Place of study (1)学校名 Name of School (2)所在地 Address 電話番号 Telephone No. (3)学校種類Classification of school 大学院 大学 短期大学 専修学校（日本語教育以外） Graduate schoolUniversityJunior collegeAdvanced vocational school (except Japanese language school) 各種学校（日本語教育以外） 日本語教育機関 Vocational school (except Japanese language school)Japanese language institution 高等学校 中学校 小学校 他 （） Senior high schoolJunior high schoolElementary schoolOthers (4)授業形態Type of class 昼間制 昼夜間制 夜間制 Day classesDay-Evening classesEvening classes 制 （双方向通信遠隔授業受場合記入） Satellite program (fill in this box when attending remote classes that use two-way communication) 通信制 （単位一部又等教育取得場合含。） Correspondence course (including cases receiving credits for education via video or internet) (5)教育受校舎所在地 Address of the school where the applicant will be educated 電話番号 Telephone No. (6)生活指導担当者名 （通学先専修学校，各種学校，中学校又小学校場合記入） Name of the resident adviser in Japan (in case that the place of study is an advanced vocational school,vocational school, junior high school or elementary school) (7)学生交換計画有無及当該計画策定主体 (通学先高等学校，中学校又小学校場合記 Is the applicant participating in a student exchange program? Which organization is in charge of that program? (when the place of study is senior high school,junior high school or elementary school) 国又地方公共団体機関 独立行政法人 国立大学法人 学校法人 National or local governmentIncorporated administrative agencyNational university corporationEducational foundation 公益社団法人又公益財団法人 他 （） Public interest incorporated association or public interest incorporated foundationOthers 3 入学年月日日 Date of entranceDay 4 週間授業時間 Lesson hours per week 5 在籍区分Registration 大学院 （博士） 大学院 （修士） 大学院 （研究生） DoctorMasterGraduate school (Research student) 大学 （学部生） 大学 （聴講生科目等履修生） 大学 （研究生） Undergraduate studentUniversity (Auditor elective course student)University (Research student) 大学 （別科生） University (Japanese language course student) 短期大学 （学科生） 短期大学 （聴講生科目等履修生） 短期大学 （別科生） Junior college (Traditional student)Junior college (Auditor elective course student)Junior college (Japanese language course student) 高等専門学校 Higher advanced professional school 専修学校 （専門課程） 専修学校 （高等課程） 専修学校 （一般課程） Advanced vocational school (Specialized course)Advanced vocational school (Higher course)Advanced vocational school (General course) 各種学校 Vocational school 日本語教育機関 （専修学校専門課程） 日本語教育機関 （準備教育課程） Japanese language institution (Advanced vocational school of specialized course)Japanese language institution (Preparatory courses) 日本語教育機関 （他） 高等学校 Japanese language institution (Others)Senior high school 中学校 小学校 他 （） Junior high schoolElementary schoolOthers Month 月年 Year 有 無 Yes / No 所属機関等作成用 （留学）在留期間更新在留資格変更用 For organization, part 2 P (Student)For extension or change of status 6 学部課程 Faculty / Course （5大学院 （博士）大学 （研究生），短期大学 （学科生），短期大学 （聴講生科目等履修生）場合記入） 法学 経済学 政治学 商学 経営学 文学 Law EconomicsPoliticsCommercial scienceBusiness administrationLiterature 語学 社会学 歴史学 心理学 教育学 芸術学 LinguisticsSociologyHistoryPsychologyEducationScience of art 他人文社会科学 （） 理学 化学 工学 ScienceChemistryEngineer 農学 水産学 薬学 医学 歯学 AgricultureFisheriesPharmacyMedicineDentistry 他自然科学 （） 体育学 他 （） Others(natural science)Sports scienceOthers 7 専門課程名称 （5高等専門学校各種学校場合記入） Name of specialized course (Check one of the followings when your answer to the question 5 is higher advanced professional school vocational school) 工業 農業 医療衛生 教育社会福祉 法律 EngineeringAgricultureMedical services / HygienicsEducation / Social welfareLaw 商業実務 服飾家政 文化教養 他 （） Practical commercial businessDress design / Home economicsCulture / EducationOthers 8 卒業所要年数年 Period of education until graduationYear(s) 以上記載内容事実相違。以上記載内容事実相違。I hereby declare that the statement given above is true and correct 通学先又所属機関名，代表者氏名記名及押印申請書作成年月日通学先又所属機関名，代表者氏名記名及押印申請書作成年月日 Name of the place of study or organization and representative, and official seal of the organization Date of filling in this form 印年月日 SealYearMonthDay 注意注意Attention 申請書作成後申請記載内容変更生場合，所属機関等変更箇所訂正，押印。申請書作成後申請記載内容変更生場合，所属機関等変更箇所訂正，押印。 In cases where descriptions have changed after filling in this application form up until submission of this application, the organization must correct the part concerned and press its seal on the correction. (Check one of the followings when the answer to the question 5 is doctor university (research student), junior college (Traditional student), junior college(auditor elective course student).) Others(cultural science/ social science) 申請書申請人等作成用，所属機関等作成用，在留目的従，次様式使用。 Select type of form which corresponds to the purpose of residence in Japan. 123412345 1短期滞在 Temporary Visitor親族訪問，短期商用 Visiting relatives, Temporary business 大学等研究指導又教育等大学教授 Activities for research, research guidance or education at collegesProfessor 中学校，高等学校等語学教育等中学校語学教師 Activities to engage in language instruction at junior high schools and high schools, etc.Junior high school language teacher 収入伴芸術上活動 Activities for the arts that provide an income作曲家，写真家 Composer, Photographer 収入伴学術芸術上活動又日本特有文化技芸研究修得茶道，柔道修得者 Academic or artistic activities that provide no income, or activities for the purpose of pursuing learningStudy tea ceremony, judo and acquiring Japanese culture or arts 外国宗教団体派遣行布教活動司教，宣教師 Religious activities conducted by foreign religious workers dispatched by foreign religious organizationsBishop, Missionary 外国報道機関契約基報道上活動新聞記者, 報道 Journalistic activities conducted on the basis of a contract with a foreign press organizationJournalist, News photographer 日本事業所期間定転勤研究活動従事外資系企業研究者 Activities of research who have been transferred to a business office in Japan for a limited period of timeResearcher assigned to a foreign firm 日本事業所期間定転勤専門的技術等必要業務外資系企業駐在員 従事 Activities of specialists who have been transferred to a business officeEmployee assigned to a foreign firm in Japan for a limited period of time 投資事業経営又管理外資系企業社長， 取締役 Investment, Operation or ManagementPresident , Director of a foreign firm 契約基収入伴研究行活動政府関係機関， 企業研究者 Activities to engage in research that provide incomeReseacher of a government body or company 自然科学分野専門的技術又知識必要業務従事機械工学等技術者 Activities to engage in services which require knowledge pertinent to natural science fieldsEngineer of mechanical engineering 人文科学等分野専門知識等必要業務従事通訳， Activities to engage in services which require knowledge pertinent to human science fieldsInterpreter, Designer 熟練技能要業務従事外国料理調理師，指導者 Activities to engage in services which require skills belonging to special fieldsForeign cuisine chef, Sports instructor 特定研究活動，研究事業活動，情報処理活動指定機関研究者情報処理技術者 Designated activities to engage in research, business related to research or information-processing-Researcher or Information-technology engineer of a related servicesdesignated organization 8興行 Entertainment歌手， Singer, Model 9技能実習 Technical intern training技能実習生 Technical intern traineeY-YYYYY 10勉学 Study留学生 Student 研修実務研修行研修生，公的研修 Training行研修生 Trainees not including in the on-the-job training, trainees who participate in public training 商用就職目的者，文化活動又留学在留資格有者扶養 受 Dependent who lives together with their supporter 特定研究活動等行者扶養受 Dependent who lives together with their supporter whose status is Designated Activities(a/b) EPA看護師又介護福祉士活動行者扶養受 Dependent who lives together with their supporter whose status is Designated Activities (Nurse and Certified Careworker under EPA) 日本人，永住者等婚姻関係，親子関係等基本邦居住日本人配偶者 Spouse or child of Japanese national, Permanent resident, etc.Spouse of Japanese national 上記以外目的 Other purposes （注意事項） Notes 申請書事実反記載判明場合，不利益扱受。 In case of to be found that you have misrepresented the facts in an application, you will be unfavorably treated in the process. 所定欄記載，別紙記載上，添付。 When the space provided is not sufficient for your answer, write on a separate piece of paper and attach it to the application. 用紙大，日本工業規格。 All parts of this application must be on JIS size A 4 Paper (210297 ). 公私機関又個人契約基在留資格芸術活動行場合，在留資格報道活動行場合，所属機関等作成用申請人作成。 次申請，所属機関等作成用提出不要。 In cases of the following applications, there is no need to submit the application form for the organization. （） 留学生大学等卒業後継続就職活動行特定活動在留資格変更許可申請及同在留資格在留期間更新許可申請 Application for changing the status of residence to Designated Activities or for extension of the period of stay for a college student to continue job hunting after graduation （）目的特定活動在留期間更新許可申請 Application for extension of the period of stay of Designated Activities for a working holiday （） 難民認定申請行者特定活動在留資格変更許可申請及同在留資格在留期間更新許可申請 Application for changing the status of residence to Designated Activities or extension of the period of stay for a person who is applying for refugee recognition 法定代理人本人代申請。 The legal representative of the applicant may make an application in lieu of the applicant. 次掲方本人代申請手続（旅券等提示及申請書等提出）行。 The following persons may complete the application procedure (submit the passport, residence card and application form, etc.) in lieu of the applicant. （）受入機関等職員又公益法人職員，地方入国管理局長適当認（本人又法定代理人依頼場合） （）弁護士又行政書士所属弁護士会又行政書士会経由所在地管轄地方入国管理局長届出（本人又法定代理人依頼場合） （）親族又同居者若準者地方入国管理局長適当認（本人歳未満又疾病他事由自申請手続行場合） When engaging in the activities Artist not based on a contract with a public or private organization