円でお支払い ¥1000 JPY each visa, Discounted until midnight Monday, 31 Jan 2022

1) ビザの種類:

Stay UP TO 3 months per visit. Multiple re-entry permitted.

NOTE: Australian Holiday, Tourist, Travel and Visitor visas are now all the SAME.


2) 今現在あなたがいる国:

3) 連絡先電話番号:
 
3a) 携帯電話番号
*** 携帯電話を含む緊急時のテキストメッセージ連絡先

Top of page 4) Eメールアドレス (Email):
4a) 確認として再度Eメールアドレス:
 

5) 申請人のパスポート番号:
5a) 確認として再度パスポート番号:
 

Top of page 6) どこの国のパスポートですか? ?
 
6a) 日本 Personal ID Number
This ID number is in your passport.
    * IF applicable - this ID number will be shown in your passport.
  • This ID number is in your passport.
  • Brunei = National IC number
  • Hong Kong = HKID number
  • Singapore = IC number
  • Malaysia = Nombor Pengenalan
  • Korea = Personal Number
  • Pls double check with applicant if you are applying for someone else.
  • AMERICANS: (NOT your SSN - social security number)
  • EUROPEANS: Your Personal ID number is listed in your passport. This number is either all numbers or numbers with a hyphen (eg: 123456-7890)
  • This personal ID Number will be listed in your passport. IF NOT shown in passport, please continue.

Top of page 7) 申請人の生年月日:
 

8) 性別:
 

9) 出生国:
 

Top of page 10) パスポート発行年月日:
 

11) パスポート有効期間満了日:
 

12) 発行官庁
発行官庁.
* その他の場合は、下記に英字で入力してください
 

13) 申請者名
  • タイトル(敬称、称号)は入力しないでください。
13a) 姓
    タイトル(敬称、称号)は入力しないでください。
  • NO TITLES (Do not put Ms, Miss, Mr, Mrs, Dr, Herr, Frau etc)
  • NO Middle TITLES such as Bin, Binte, Bte, S/O, D/O, Anak etc
  • NO POST TITLES (Do not put Jr, Snr, I, II, III, IV etc)
13b) 名:
姓の欄に名を入力しないでください
13c) 名: * 該当する場合
姓の欄に名を入力しないでください
 

Top of page 14) 申請者の現住所
私書箱は受け付けておりません
申請者それぞれの現住所を入力してください。
現住所(英字で入力、私書箱の住所は受け付けておりません):
現住所のみ 1:
郵便番号 eg: 001-0123
例 (英字で入力)
4-3-2-1 #123 Minami-Sapporo Shiroishi-Ku Sapporo-Shi Hokkaido
都道府県:
OTHER

私書箱は受け付けておりません.

 

Top of page 15) 犯罪歴

今までに12か月以上の刑事上の有罪判刑を受けたことがありますか?

上記の有罪判決にかかわらず詳細は必要とされていません.

 

Top of page 16) Name Changes: IMPORTANT - NEW NOV 2019

申請者はかつて法的に変更した名前を他に持っていますか?
結婚などで姓に変更があった場合を含みます。

IF YES, please fill in the following details:

IF NO, please go to question 17

 
Surname at Birth / Maiden Name
Given Name(s) at Birth
Gender
Date of Name Change
Reason for Name Change?
 
 
! Important ! New questions 2022
Has the applicant been legally been known by a SECOND Name or Alias?
 

IF YES, please fill in the following details.

IF NO, please go to question 17

 
Surname / Last Name
ALL Given Names in Passport
Gender
Date of Name Change
Reason for Name Change?
 
 
! Important ! New questions 2022
Has the applicant been legally been known by a THIRD NAME?
 

IF YES, please fill in the following details.

IF NO, please go to question 17

Surname / Last Name
ALL Given Names in Passport
Gender
Date of Name Change
Reason for Name Change?
 

Top of page 17) Other Citizenship?
Does the applicant hold Citizenship for ANY OTHER COUNTRIES ?

If YES

Does the applicant have a Passport for that country?
Citizenship 2 Surname / Last Name
Citizenship 2 ALL Given Names in Passport
Citizenship 2 Passport Number
Country of Passport
 
Citizenship 2 Passport Issued
Citizenship 2 Passport Expires
Citizenship 2 Date of Birth
 
Citizenship 2 Gender
 
 

Top of page 18) MEDICAL RECORD

Has the applicant ever had any of the following?

Details are NOT required.

YES: EBOLA
YES: HIV / AIDS
YES: HEPATITIS
YES: CORONAVIRUS
NONE OF THESE
 
19) DOMESTIC VIOLENCE

Has the applicant ever had any of the following?

Details are NOT required.

Question 1:

Has the applicant ever been charged or convicted of a family or domestic violence offence or any similar related offence?

  YES     NO

Question 2:

Has the applicant ever had a domestic violence or family violence order, or any other similar order, of a tribunal or court or other similar authority for the personal protection of another person - taken out against them?

  YES     NO
 

Top of page 20) I AGREE that I have double checked the above information.
 

 
 
 
     
   
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