APPLICATION FOR ADMISSION
JAPANESE STUDY TOUR WINTER 2009

FULL NAME ：
(SURNAME) (GIVEN NAME)

NATIONALITY ：


SEX ：
M 　 F

DATE OF BIRTH ：
19 (YEAR) ： (MONTH) ： (DAY)

SINGLE 　 MARRIED

OCCUPATION ：


PLACE OF BIRTH：

HOME ADDRESS：

TEL：

MOBILE：

■PASSPORT
PASSPORT NUMBER ：

DATE OF ISSUE：
(YEAR) ： (MONTH) ： (DAY)

VALID UNTIL：
(YEAR) ： (MONTH) ： (DAY)

■STATUS OF RESIDENCE(VISA) WHEN YOU ADMIT
STATUS OF RESIDENCE：


■FAMILY,RELATIVES OR FRIENDS’ CONTACT LISTS IN EMERGENCY
IN JAPAN ( IF ANY )
FULL NAME：
(SURNAME) (GIVEN NAME)

RELATION ：

ADDRESS：


TEL：

MOBILE：

NATIONALITY：


IN HOME COUNTRY
FULL NAME ：
(SURNAME) (GIVEN NAME)

RELATION ：

ADDRESS：


TEL：

MOBILE：

NATIONALITY：


■LAST EDUCATION
SCHOOL NAME ：


(YEAR) ： (MONTH) ： (DAY)

GRADUATED 　 STUDYING 　 STOP OUT 　 LEFT

■INTENDED ENTRY TO JAPAN
(YEAR) ： (MONTH) ： (DAY)

■PICKUP
NO NEED　　 OCAT(NO FEE) 　　 KANSAI AIRPORT(NEED FEE : Click here to see more details)

■I hereby declare the above statement is true and correct.
DATE：
(YEAR) ： (MONTH) ： (DAY)

SIGNATURE：


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