Japan visa form

Please fill in your information on this form.

Personal detail

(as shown in passport)
Given and middle names  
(as shown in passport)
Other names
(including any other names you are or have been known by)
Date of birth   Date: / Month: / Year:
Place of birth  
(City / State or Provience / Country )
Marital status  
Nationality or citizenship  
Former and/or other nationalities or citizenships
ID No. issued to you by your government  

 Passport detail

Passport No.  
Place of issue  
Issuing authority  
Date of issue   Date: / Month: / Year:
Date of expiry   Date: / Month: / Year:

 Your current residential detail

(if you have more than one address, please list them all)
Telephone No.   Tel / Mobile

Have you ever: 

* Please tick “Yes” if you have received any sentence, even if the sentence was suspended. 

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?  

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

 Transmission procedure

Step 1

Push the Confirm [確認する] button.

Step 2

Confirm information.

(that indication begins by a rubric if there is an error.)

Step 3 

Push the transmission [送信する] button.

(If there is not an error, a transmission button is displayed.)