Application form TOP Application form 【Contractor】 Application NumberRequired NameRequired Name（Katakana）Required Name（Chinese Characters）Optional Date of BirthRequired --- 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year --- 1 2 3 4 5 6 7 8 9 10 11 12 Month --- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day SexRequired Male Female Current AddressRequired Phone NumberRequired Email AddressRequired Visa TypeOptional Student Working Designated Activities Tourist Others Reason for Moving Optional Education Work Others Emergency Contact：Parent in your home country (father or mother) NameRequired Date of BirthRequired --- 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year --- 1 2 3 4 5 6 7 8 9 10 11 12 Month --- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day RelationshipRequired -- Father Mother Sibling Relative Others SexRequired Male Female Current AddressRequired Same as contractor Phone NumberRequired Email AddressRequired 【Optional Services】 Purchase Futon Single size: 10,000 yen Semi-double size: 15,000 yen Double size: 20,000 yen Optional Need Not Needed Request for electricity / gas opening application after receiving and accepting the explanation of the important matter explanation of 'Electricity supply and demand contract' About electric gas application service Agree to our privacy policy About our privacy policy The provisional application period is approximately one week.Please note that we may not be able to accept your application depending on the details provided.Our representative will contact you with further details. *If we receive two or more applications from the same customer, we will prioritize the most recent one. We use RapidSSL to protect your personal information.On websites with URLs starting with "https," all data is encrypted using SSL before being sent or received.
