ページ内を移動するためのリンクです。
List of application forms
現在表示しているページの位置です。
  • HOME
  • List of application forms

List of application forms

Forms related to health insurance cards and eligibility

Title of formDownload
notice/application form
Download example of
completed notice/form
Application Form for Reissue of Health Insurance Card (Card loss/Damage)
Notification of Health Insurance Card Loss
Notification of Loss of Eligibility as Health Insurance Dependent
Notification of Loss of Eligibility as Health Insurance Dependent (for period of receipt of unemployment benefits)
Application Form for Dependent Certification
Unemployment Benefits Receipt Confirmation Form
Unemployment Benefits Waiver Confirmation Form.
Survey Form of Livelihood Dependency on Insured Person
Notice of Change to Registered Health Insurance Information
Application Form for Certification as Health Insurance Voluntarily and Continuously Insured Person
Notification of Long-term Care Insurance (Qualification/Disqualification) (Insured Person)
Application form for reissue of specified health diagnosis examination ticket/health guidance ticket

Forms related to benefits and claims

Title of formDownload
notice/application form
Download example of
completed notice/form
Claim for Medical Care Expenses (Insured Person, Dependent)
Letter of Consent to Investigation
Request for issuance of Maximum Co-payment Certificate for Health Insurance
Application Form for Approval of Transportation
Application Form for Transportation Expenses
Claim for Injury and Sickness Allowance/Additional Sum
Claim for Maternity Allowance/Additional Sum
Claim for Childbirth and Childcare Lump-sum Grant (Insured Person, Dependent)
Claim for Funeral Expenses/Funeral Costs (Insured Person, Dependent)
Application for Payment of High Aggregate Cost for Long-Term Care Service
Application Form for Issuance of Copayment Certificate (Aggregation for Long-Term Care Service for the Aged)
Health Insurance Application for Payment of Benefits (Outpatient Annual Aggregate)/Issuance of Copayment Certificate for
High-cost Medical Expenses
Application Form for Certificate Issued for Specific Disease Treatment

Forms related to third-party actions (including traffic accidents)

Title of formDownload
notice/application form
Download example of
completed notice/form
Notification of Injury or Sickness due to a Third-party Act
Written Pledge
Interim Report on Traffic Accident
Notice of Completion of Treatment
Application Form for Exemption from Refunding of Insurance Benefits

Forms related to traffic accidents caused by your own negligence

Title of formDownload
notice/application form
Download example of
completed notice/form
Notice of Accident Due to Own Negligence
Page Top