A List of Basic Documents to e Submitted for an Application for Visa for "Temporary Visit"
Short-Term Business Affairs, etc. Visits to Relatives/Acquaintances/Tourism via agency
Purpose of Cultural exchanges(except for a private)
Visit Sports exchanges
Participation in meetings(conferrence,etc)
Business affairs (business liaison, after-sales services,etc)
*If necessary, Japanese consulate might ask for additional documents apart from the documents mentioned below.
*AII documents can use only within 3months from the issued date.
(Provided by visa applicant)
Documents (l)Visa application l(filled by visa applicant)
to be (2)Photo l(taken within 6months)
submitted (3)Passport
(4)Certificate of employment/Student enrollment/
/business registation (in accordance with Korea visa)
(5)bank passbook copy(list for 6months) '
(6)Copy of ARQAlien registration card) of Korea
(7)Confirmation slip for the airline, accommodation-
-Please do not pay early before get a Japan visa.
(Provided from Japan organization)
(l)Letter of reason for invitation
(2)Letter of guarantee
(3)Schedule of stay
*Aboves are should be written by a guarantor
with the specific forms of MOFA
(4) One of the following documents
a. Copy of the incorporation register,
b. Copy of the latest Kaisha Shikiho
(Japan Company Handbook),
c."overview of the company/organization"
(In case not registered as incorporation)
(5) A pamphlet regarding a visit purpose
(6) List of visa applicant (more than 1 person)
(Note 1)
If a person of the iviting company/organization
to be a guarantor, require all Certificate of
employment, Income Tax, residence certificate.
(Note 2)
In case of Purpose take part in conferrence, it
would be acceptable the certificate of professor
instead of incorporation register. All documents
should be wrote as name of professor though.
(Note 3)
In the case of aggregate corporations/foundations,
submit the following documents in lieu of (4);
(1) The articles of aggregate corporations, funds of
foundations, aggregate corporation/foundations
brochure, etc.
(2) balance sheets of revenue and expenditure (not
necessary when associations/foundations are within
the jurisdiction of state.
*Please be know that a mark would be stamped on your passport by consulate if visa application were cancelled or refused.
*Visa application time is from9:30~ll:30am, l:30~4:00pm. (Mon~Friday)
The applicant may be required to submit additional documents which are deemed necessary for the examination.
Originals should be submitted within 3months from date of issue. Documents submitted at the time of application are not to be returned to the applicants, except for passports.
Tourism not meet someone in Japan
Visits to blood relatives/relatives
Visits to acquaintances (friends)
Tourism via agency(Russian and NIS nations only)
purpose of entry as the "visit", not the
tnnricm
(Provided by visa applicant)
(l)Visa application l(filled by visa applicant)
(2)Photo l(taken within 6months)
(3)Passport
(4)Certificate of employment/Student enrollment/Certificate
of business registation (in accordance with Korea visa)
(5)Copy of bank passbook(list for 6months) or statements*
(6)Copy of certificate of alien registration
(7)Schedule of stay
(8)Confirmation slip for the airline and accommodation
-Please do not pay early before get a Japan visa.
(9)Documents to prove relationship with inviter/guarantor
(In case of visit to relatives)-One of the belows
a. Certified Copy of the family register
b. family certificate/ Marriage certificate*'
(In case of visit to acquaintances)- One of the belows
a. Letters and e-mails exchanged
b. Bills for international phone calls
c. Photos taken together with inviting person & ID copy
(If any material to prove well known.each other)
(Provided from inviter/guarantor of Japan) ;
(l)Letter of reason for invitation (Specific form*'5,by inviter)
(2)Schedule of stay (Specific form by inviter)
(3) Certificate of residence(certificate of all items)
- Chinese be required more 3years status
(4)Certificate of employment(or incorporation register) etc.
*If guarantor is such as a pensioner, needed the document
to prove who is a pensioner
(5)Copy of both sides the resident card and passport
- Just in case of a foreigner
(6)Letter of guarantee (Specific form by guarantor)
(7)Certificate of Income/Taxation, or a copy of the counterfoil
of final tax return with seal (for "e-Tax", Receipt notification
and Receipt notification and final tax return)
with the gross income of last year
(8) List of visa applicant (more than 1 person)
(9) Documents on the inviting person
(when the inviting person is different from the guarantor, should
prove the relations by documents like a kouseki)
(10) Matterials can prove visa applicant will act as the schedule
of stay which made by an inviter
(like a accommodation's reservation sheet or diagnosis)
Specific Forms as aboves can be downloading from webs
Tourism only
*A purpose to meet the
acquaintance/relatives will be regarded the
(Provided by visa applicant)
(l)Visa application l(filled by visa applicant)
(2)Photo l(taken within 6months)
(3)Passport
(4)Certificate of employment/Student
enrollment/Business registation
(One of above in accordance with Korea visa)
(5)Copy of bank passbook(list for 6months)
or the withdrawal & deposite statements*
*Lend [loan] money not allowed.
(6)Copy of certificate of alien registration
(7)Family registration (dependent visa holder only)
Sufficient that one issued by Korea immigration
(8)Schedule of stay
*Be sure to be match with the flight and
accommodation booking before apply a visa.
(9)Confirmation slip for the flight and
accommodation
^10) Copy of passport (visa) of accompany. -
Nation not required visa, only passport
ci iffiripnt
iPlease do not pay for it early before get a
Japan visa.
Some of Korea visa holder may require the
guarantor at the middle of examination by
a consul.
Regardless of the entry purpose, Russian
nationals and nationals of NIS (Armenia,
Azerbaijan, Belarus, Georgia, Kazakhstan,
Kyrgyzstan, Moldova, Tajikistan, Turkmenistan,
Uzbekistan, Ukraine) and some countries in
Africa, need a guarantor in Japan to apply a
Visa.
(Provided from Japan travel agency, Russian
and NIS nations only)
Please refer to the website of MOFA of
Japan, www.mofa.go.jp -> Visa -> Russia
and NIS countries.
http://www.mofa.go.jp/j
info/visit/visa/short/ru
ssia_nis.html
ite : www.mofa.go.jp
 CHONBUK
NATIONAL UNIVERSITY
Deokjindong 1-ga, Deokjin-gu, Jeonju-si, Jeollabuk-do [561-756] Korea
+82-63-270-2342
To
Japan Embassy
Seoul

Dear Sir/Madam

RE: Financial support for Mr. Jayaraman Balamurugan - MANA RSC Symposium

This is to confirm that I will financially support my employee (Mr. Jayaraman Balamurugan)
for attending the conference, MANA RSC Symposium, Materials for Energy Generation and
Storage from 14th October to 18th October 2015, Tsukuba, Japan. This includes financial
support for conference registration, flight tickets (two ways), accommodation and living cost
for his stay in Japan.
Professor, Head of Dept, of
BIN Fusion Technology
Director, Center for Carbon
Composite Materials
Director, Advanced Wind
Power System Research
Center Chonbuk National
University Duckjin-dong
IGa 664-14 Jeonju,
Jeonbuk, 561-756 South
Korea
E-mail: ihl@chonbuk.ac.kr
Tel: 82-63-270-2342, Fax :
82-63-270-2341

Sincerely

r
Joong-Hee Lee, Ph. D.
ITR rAH (S) 121 5IHI0IXI

e-Ticket Itinerary & Receipt

SEIIIIOIEim(^) ...TOMS
JUNGBOHYE ( Tel 02-000-0000 , Fax 02-000-0000 ) bhjeong@lottejtb.com /
AdDj JAYARAMAN/BALAMURUGA
CO 1 CO CO
Passenger Name
NMR

oil stas Booking Reference 3276-6513

tt-gsas Ticket Number 1809702693005

OIS Itinerary
Flight KE0701 (oj|^tH2:3K9TAT) Operated by KE(KOREAN AIR)

Hit Departure AHM(ICN/Incheon inti) 140CT15 08:00 Local Time Terminal No. : -
Arrival 5ES(NRT/Narita) 140CT15 10:30 Local Time Terminal No .:1

&||Aty|iyAlZ} Flight Time 02H 30M SKYPASS 1-115.1 X! 1 SKYPASS Miles 758
oilst^S Class E (Sa1l) #53 ^57R} Not Valid Before -
2ts E)oj Seat Type - Not Valid After 14APR16
OIISTSEH Status OK (*tst) Baggage 1PC
<? Ol Fare Basis ELEKJ3
nr cu
AIRBUS INDUSTRIE
7IW Aircraft Type
A330-300

aS Flight KE0704 (o||^0S::3K9TAT) Operated by KE(KOREAN AIR)

Sit Departure ES(NRT/Narita) 180CT15 13:55 Local Time Terminal No. : 1

JEE^t Arrival AjH(ICN/Incheon inti) 180CT15 16:20 Local Time Terminal No. : -

oi|Aty|iil?i Flight Time 02H 25M SKYPASS l^5.|x| SKYPASS Miles 758
Oil St# s Class E (#M) #sa #s7ia- Not Valid Before -
SIS E^OJ Seat Type -
Not Valid After 14APR16
oHst^tEH Status OK (*M-sf) i# Baggage 1PC

Date of birth _ 09/07/1980 Place of birth INDIA

(Oay)/(Month)/(Year) (City) (State or Province) (Country)

Sex: Male [x] Female Marital status: Single Married \x\ Widowed Divorced
Nationality or citizenship INDIA ___________________________________________________________ __________________ [3
Former and/or other nationalities or citizenships ________________________________________________________
ID No. issued to you by your government ______________________________________________________________________

Passport type: Diplomatic ED Official [x] Ordinary EH Other ED Passport No.

K0038421 ___________________________________________________________________

Place of issue CHENNAI ____________________________________________________ Date of issue 10/12/2011

(Day)/(Month)/(Year)
Issuing authority Government of India ______________________________________ Date of expiry 09/12/2021
(Day)/(Month)/(Year)

Purpose of visit to Japan CONFERENCE _________________________________________________________________________

Intended length of stay in Japan 5 Days ________________________________________________________________________

Date of arrival in Japan 14/10/2015 ______________________________________________________________________________

Port of entry into Japan Narita ________ Name of ship or airline KE07Q1 (Korean Air) _______________
 -1! Fare Basis ELEKJ3
7|# Aircraft Type BOEING 747-400
* EExr Oi|ot ^^0)1 ctp) o^a|x| 5jmo| o^a|x|7|- *ll|x|
* H-^71 7|#-g- AjXjJlXl &0[ %^A\ HlgD t h Dg7| Jflx|| #S| ^0| fi- A^^
Ajitj^Aj 3E|-ijo| Hjgi t XISM A| 71# y sHtfM nnm tAPI uHfHct.
* S.-E SSAm gst A^Oll 2ISII-H m Siraul CK

Ticket/Fare Information
aas-sa Conj.Ticket No.
sa-fcifcm! Fare Calculation

Fare Amount
*IMSWI Equiv. Fare Paid
Taxes/Carrier-imposed Fees
* -Ml o' Taxes
Fuel Surcharge
Service Fees
gA^^OH Total Amount
Form of Payment

e-Ticket Issue Date/Place

SEL KE TY0156.92KE SEL156.92NUC313.84END ROE1115.199000
KRW 350000 (Paid Amount KRW 350000)

Paid Amount KRW 54000 KRW 28000BP 20800SW 520001

KRW 0
KRW 404000 (Total Paid Amount KRW 404000) CCCA
XXXXXXXXXXXX3081 / 1218/00
30SEP2015 / 17326190 / KWJK131BA

Names and addresses of hotels or persons with whom applicant intends to stay
Name Toyoko Inn and Monterey Hanzomon ___________________________ Tel. +81 298631045_____________
Yubinbango, 305 087, Tsukuba, Ibaraki Perfecture Research, Gakuen 5-13-7 Address ____________

Dates and duration of previous stays in Japan - Nil - ____________________________________________________________

Your current residential address (if you have more than one address, please list them all)
Room 202,9-2 Samsung, Deokjin-gu, Jeonju-si, Jeollabuk-do, Republic of Korea Address ________

Tel. +82 1047196684 Mobile No. +82 1021975918

Current profession or occupation and position Post Doctoral Researcher _______________________________________
Name and address of employer
Name JOONG HEE LEE ________________________________________________ Tel. +82 632702342 ____________
BIN Convergence, Baekje-daera, Deojin, Chonbuk National University, Jeonju, 561-756
Address
Address _____________________________________________________________________________
Date of birth __________________ Sex: Male [x] Female
(Day)/(Month)/(Year)
Relationship to applicant ____________________________________________________________
Profession or occupation and position _______________________________________________
Nationality and immigration status __________________________________________________
 VISA APPLICATION FORM TO ENTER JAPAN

Surname (as shown in passport) JAYARAMAN ______________________________

Given and middle names (as shown in passport) BALAMURUGAN_______________________________________________
Other names (including any other names you are or have been known by)
^Partner's profession/occupation (or that of parents, if applicant is a minor):
Guarantor or reference in Japan(Please provide details of the guarantor orthe person to be visited in Japan)
Name Hiromitsu Urakami ______________________________________________ Tel. +81 355774360
RSC, Kagakukaikan 6F, 1-5 Kanda-Surugadai, Chiyoda-ku, Tokyo 101 0062, Japan Address
Date of birth __________________ Sex: Male 0 Female
(Day)/(Month)/(Year)
Relationship to applicant Event Contact _________________________________________________________
Profession or occupation and position __________________________________________________________
Nationality and immigration status ______________________________________________________________
Inviter in Japan(Please write 'same as above' if the inviting person and the guarantor are the same)
Name Same as above __________________________________________________ Tel. Same as above
Same as above

YesD N
o
Yes
D N
o

YesQ N
o

N
YesD o

N
Yes
D o
N
Yes
D o
 VISA APPLICATION FORM TO ENTER JAPAN

Surname (as shown in passport) NGUYEN ______________________________________

Given and middle names (as shown in passport) THANH TUAN ________________________
Other names (including any other names you are or have been known by)

Date of birth 18/03/1984 Place of birth Thuy Nguyen __________________ Hai Phong ____________ Viet Nam _____________
(Uay)/(Month)/(Year) (City) (State or Province) (Country)

Sex: Male [x] Female Marital status: Single Married [x] Widowed Divorced

Nationality or citizenship VIETNAMESE _________________________________________________________

Former and/or other nationalities or citizenships _____________________________________________________________

ID No. issued to you by your government 162409691 _________________________________________________________________

Passport type: Diplomatic Official Ordinary \x\ Other

Passport No. B7786652 ________________________________________________________

Place of issue Vietnam _________________________________________________________ Date of issue 30/03/2013

(Day)/(Month)/(Year)
Issuing authority Immigration Department Date of expiry 30/03/2023
(Day)/(Month)/(Year)
Purpose of visit to Japan for conference ______________________________________________________________________________
Intended length of stay in Japan 5 days ______________________________________________________________________________

Date of arrival in Japan 14/10/2015 ___________________________________________________________________________________

Port of entry into Japan Narita Airport_________________ Name of ship or airline KE0701_______________________________

Names and addresses of hotels or persons with whom applicant intends to stay
Name Toyoko Inn and Monterey Hanzomon ______________________________ Tel. +81 298631045 ______________

Address Yubinbango, 305 087, Tsukuba, Ibaraki Perfecture Research, Gakuen 5-13-7 _________________________

Dates and duration of previous stays in Japan ________________________________________________________________________

Your current residential address (if you have more than one address, please list them all)

Address Room 101,10-8 Maebong 6-gil, Deokjin-gu, Jeonju-si, Jeollabuk-do, Republic of Korea

Tel. ____________________________ Mobile No. +82 1027859635

Current profession or occupation and position Student at Department of BIN Convergence Technology Name and

address of employer
Name Prof. Joong Hee Lee ________________________________________________ Tel. +82632702342 ______________

Address Department of BIN Convergence Technology, Chonbuk National University, Jeonju, Korea
 ^Partner's profession/occupation (or that of parents, if applicant is a minor):
Guarantor or reference in Japan(Please provide details of the guarantor or the person to be visited in Japan)
Name Ms Yoshiko Fukuda ________________________________________________ Tel. +81355774360

Address Kagakukaikan 6F, 1 -5 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan Date of

birth ____________________ _______ Sex: Male Female [x]

(Day)/(Month)/(Year)

Relationship to applicant ____________________________________________________________________________

Profession or occupation and position Administrative Assistant _____________________________________
Nationality and immigration status Japanese ________________________________________________________
In Viter in Japan(Please write same as above' if the inviting person and the guarantor are the same)

Name same as above Tel. same as above

Address same as above

Date of birth ____________________ Sex: Male Female [x]
(Day)/(Month)/(Year)
Relationship to applicant __________________________________________________
Profession or occupation and position
Nationality and immigration status _______
*Remarks/Special circumstances, if any
Have you ever:
been convicted of a crime or offence in any country? YG No[x]

been sentenced to imprisonment for 1 year or more in any country?** VesQ No[x]
been deported or removed from Japan or any country for overstaying your visa or
violating any law or regulation? YesQ No[x]
been convicted and sentenced for a drug offence in any country in violation of law
concerning narcotics, marijuana, opium, stimulants or psychotropic substances?**
engaged in prostitution, or in the intermediation or solicitation of a prostitute for other YesQ No[x]
persons, or in the provision of a place for prostitution, or any other activity directly
connected to prostitution?
committed trafficking in persons or incited or aided another to commit such an offence? YesQ No[x]
** Please tick "Yes" if you have received any sentence, even if the sentence was suspended. YD No[x]
If you answered "Yes" to any of the above questions, please provide relevant details.

"I hereby declare that the statement given above is true and correct. I understand that immigration status and period of stay to be
granted are decided by the Japanese immigration authorities upon my arrival. I understand that possession of a visa does not entitle the
bearer to enter Japan upon arrival at port of entry if he or she is found inadmissible."
"I hereby consent to the provision of my personal information (by an accredited travel agent, within its capacity of representing my visa
application) to the Japanese embassy/consulate-general and (entrust the agent with)
the payment of my visa fee to the Japanese embassy/consulate-general, when such
payment is necessary."
Signature of applicant
Date of application 01/10/2015 __________
(Day)/(Month)/(Year)
* It is not mandatory to complete these items.
Any personal information gathered in this application as well as additional information submitted for the visa application (hereinafter
referred to as "Retained Personal Information") will be handled appropriately in accordance with the Act on the Protection of Personal
Information Held by Administrative Organs (Act No. 58 of 2003, hereinafter, "the Act"). Retained Personal Information will only be used for
the purpose of processing the visa application and to the extent necessary for the purposes stated in Article 8 of the Act.
ITRg H ( I) 11 5HI0IXI

50 l f l l O I E i a i ( ^ )
llJNGROHYF ( TPI 07-000-0000 . Fay 07-000-0000 'l
, _ TOP IK
e-Ticket Itinerary & Receipt
f Itinerary
JUNGBOHYE ( Tel 02-000-0000 , Fax 02-000-0000 ) bhjeong@lottejtb.com /
1216 / 30SEP15
7HAH CM
Passenger Name NGUYEIM/THANHTUANMR
Olajas Booking Reference 3276-6513
85382 Ticket Number 1809702693003

SS Flight KE0701 (W3i:3K9TAT) Operated by KE(KOREAN AIR) if 8 Departure >M4i(ICN/Incheon inti) 140CT15

08:00 Local Time Terminal No. : -

JEE^t Arrival EEjfl(NRT/Narita) 140CT15 10:30 Local Time Terminal No. : 1
0||8lA|Zi- Flight Time
02H 30M SKYPASS 383*1 SKYPASS Miles 758
oil is i Class E (8 8*1) 853 SS7IZJ- Not Valid Before -
8
2**1Departure
Efj Seat Type JE^[- Arrival
(NRT/Narita) 180CT15 13:55 Local Time Terminal No. 14APR16
Not Valid After : 1
Oil 2J8 EH Status OK (83) "4 ofs
180CT15 Baggage
16:20 Local Time 1PC
*HI(ICN/Incheon inti) Terminal No. : -
o0H8I8A|
ol Flight
Fare Time 02H
Basis 25M
ELEKJ3 SKYPASS 383*1 SKYPASS Miles 758
ET c -
Oflstss Class EAIRBUS
(88*1) INDUSTRIE 853 S7|Z Not Valid Before
1 ToEfo|
J2**1 Aircraft Type A330-300 14APR16
Seat Type Status Not Valid After
Oil 3f 8 EH
S Flight KE0704 (0||fa:3K9TAT) Operated
OK (83)by KE(KOREAN AIR) 4" 1"5 Baggage 1PC
Fare Basis ELEKJ3
s
7|
Aircraft Type BOEING 747-400
OI SK

* #oj c- OOI %^^o\ V oil Of e^oll tx|-a|- 0^B|X| aim0|

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* H-E 85AN- 58- Af0|| o|e||A-i 4= aiH3.

asfi TickeFare Information

x|*8*l Conj.Ticket No.

A||5/S5A|- i Fare Calculation SEL KE TY0156.92KE SEL156.92NUC313.84END
* All -g Fare Amount Equiv. Fare Paid R0E1115.199000
* KRW 350000 (Paid Amount KRW 350000)
-Tr^-^^- - Taxes/Carrier-imposed Fees
Taxes
Paid Amount KRW 54000 KRW 28000BP 20800SW
x| Fuel Surcharge Service Fees Total
520001 KRW 0
Amount Form of Payment e-
KRW 404000 (Total Paid Amount KRW 404000) CCCA
Ticket Issue Date/Place
XXXXXXXXXXXX3081 / 1218/00
30SEP2015 / 17326190 / KWJK131BA

8t8 88*1

* X|#3 (Total Paid Amount)0|| 7|S 82l*lA|7| UHM3.

e-E|3! 83 TLXIE# 8 = A| ^A|7| a^LcK
e-E|5j[ mss IfS4^A|, 2*^/3 *|A|*fS 4= Si O oS b_K=A| 3 Of 8 71 ZI sei :x|fA|7|
UM 3. e-E|31 8!#l OI g* 012183 0|gE i=A| S| ||o:
cj|Jf^3 a8011 Ai Dl&Aie US 850 88 40S Si^lS, 8#, of = &|7f 88S-& 1AIZ1
3) 33 SM, n 88 oj| A|zj i| 2A|Zi *]0||S 38011 Sf^A|7| dfgfLjcK

https://pssums.topas.net/UMS/doc/docPrint.jsp?&noNTCon&jspFileNamedocEtrl... 2015-09-30
 CHONBUK
NATIONAL UNIVERSITY
Deokjindong 1-ga, Deokjin-gu, Jeonju-si, Jeollabuk-do [561-756] Korea
+82-63-270-2342

To
Japan Embassy
Seoul

Dear Sir/Madam

RE: Financial support for Mr. Nguyen Thanh Tuan - MANA RSC Symposium

This is to confirm that I will financially support my student (Mr. Nguyen Thanh Tuan)
for attending the conference, MANA RSC Symposium, Materials for Energy
Generation and Storage from 14th October to 18th October 2015, Tsukuba, Japan. This
includes financial support for conference registration, flight tickets (two ways),
accommodation and living cost for his stay in Japan.

Joong-Hee Lee, Ph. D.

Professor, Head of Dept, of BIN Fusion Technology
Director, Center for Carbon Composite Materials
Director, Advanced Wind Power System Research Center
Chonbuk National University
Duckj in-dong IGa 664-14
Jeonju, Jeonbuk, 561-756
South Korea
E-mail: ihl@chonbuk.ac.kr
Tel: 82-63-270-2342, Fax : 82-63-270-2341
* x|#^0 (Total Paid Amount)^! S7|S ^UW7| u^u|c|.
e-E|5J SfoJS3l QV\\ 12*15 SJ- = A| jGl3)0j nrA|7| UfiMcf.
e-E|5! ^OJss. gf^A|, g|^/A|| #2)A| X)|A|^S
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uHju|cK e-E|?(i si-el#o| o|#n) oj^Atoi o|-s U]-HA| ^|x||of: fj-McK
c||52| #*kH|Aj mAlZ>5 US 2^0 405 a(n|^, 1^, W, o[E.E\^[ 1*12}
*!) |OjSlM, HS- 0||SA|Zt S\ 2A|Zf Sollt g*fO|| *f^A|7|

https://pssums.topas.net/UMS/doc/docPrintj sp?&noNTCon&jspFileNamedocEtrI... 2015-09-

30
*Remarks/Speciai circumstances, if any ___________________________________________________
Have you ever:
been convicted of a crime or offence in any country?
been sentenced to imprisonment for 1 year or more in any country?* **
been deported or removed from Japan or any country for overstaying your visa or violating any law or
 regulation?
been convicted and sentenced for a drug offence in any country in violation of law concerning
narcotics, marijuana, opium, stimulants or psychotropic substances?**
engaged in prostitution, or in the intermediation or solicitation of a prostitute for other persons, or in
the provision of a place for prostitution, or any other activity directly connected to prostitution?
committed trafficking in persons or incited or aided another to commit such an offence?
** Please tick "Yes" if you have received any sentence, even if the sentence was suspended.

If you answered "Yes" to any of the above questions, please provide relevant details.

"I hereby declare that the statement given above is true and correct. I understand that immigration status and period of stay to be
granted are decided by the Japanese immigration authorities upon my arrivai. I understand that possession of a visa does not
entitle the bearer to enter Japan upon arrival at port of entry if he or she is found inadmissible."
"I hereby consent to the provision of my personal information (by an accredited travel agent, within its capacity of representing my
visa application) to the Japanese embassy/consulate-general and (entrust the agent with) the payment of my visa fee to the
Japanese embassy/consulate-general, when such payment is necessary."

Date of application 30/09/2015 _____________ Signature of applicant

(Day)/(Month)/(Year)

* It is not mandatory to complete these items.

Any personal information gathered in this application as well as additional information submitted for the visa application
(hereinafter referred to as "Retained Personal Information") will be handled appropriately in accordance with the Act on the
Protection of Personal Information Held by Administrative Organs (Act No. 58 of 2003, hereinafter, "the Act"). Retained Personal
Information will only be used for the purpose of processing the visa application and to the extent necessary for the purposes stated
in Article 8 of the Act.