VISA APPLICATION FORM TO ENTER JAPAN

PASTE YOUR PHOTO HERE. DO NOT STAPLE. PHOTO SHOULD

BE CLEAR WITH WHITE COLOR BACKGROUND TAKEN WITHIN
PAST 6 MONTHS
(Paste photo here)

45mm ×35mm
*Official use only
or 2in x 1.4in

*IF YOU
ARE
MUSLIM,
FILL IN Surname (as shown in passport) WONG
FULL
NAME Given and middle names (as shown in passport) WEI WEI
HERE
Other names (including any other names you are or have been known by)

Date of birth 01/01/90 Place of birth BATU PAHAT JOHOR MALAYSIA

(Day)/(Month)/(Year) (City) (State or Province) (Country)
Sex: Male Female Marital status: Single Married Widowed Divorced
Nationality or citizenship MALAYSIAN
Former and/or other nationalities or citizenships
ID No. issued to you by your government 900101-01-0101
FOR Passport type: Diplomatic Official Ordinary Other Passport No. X11111111
THOSE
APPLYING Place of issue UTC KUALA LUMPUR Date of issue 01/01/22
WITH (Day)/(Month)/(Year)
COE, FILL Issuing authority IMMIGRATION DEPARTMENT OF MALAYSIA Date of expiry 01/01/27
IN THE (Day)/(Month)/(Year)
STATUS Purpose of visit to Japan BUSINESS / VISIT FAMILY / STUDY
STATED
IN YOUR Intended length of stay in Japan 15 DAYS/ 30 DAYS/ 1 YEAR
COE
Date of arrival in Japan 5 JUNE 2022
Port of entry into Japan NARITA Name of ship or airline MALAYSIA AIRLINE
Names and addresses of hotels or persons with whom applicant intends to stay
Name FILL IN HOTEL NAME Tel.

FILL IN YOUR TENTATIVE ACCOMMODATION ADDRESS IN JAPAN

Address
Dates and duration of previous stays in Japan 5 JANUARY TO 10 JANUARY 2021
Your current residential address (if you have more than one address, please list them all)

FILL IN YOUR CURRENT ADDRESS IN MALAYSIA

Address
Tel. Mobile No. 011-1111111
E-Mail [email protected]
Current profession or occupation and position FILL IN YOUR CURRENT PROFESSION
Name and address of employer

Name FILL IN COMPANY NAME AND ADDRESS Tel. 03-33333333

IF YOUR ARE A STUDENT, FILL IN THE UNIVERSITY/ SCHOOL NAME , ADDRESS & PHONE NO
Address
 *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)
PLEASE FILL Name Tel.
IN YOUR
INVITER AND
GUARANTOR Address
DETAILS BUT
IF YOUR ARE Date of birth Sex: Male Female
A STUDENT, (Day)/(Month)/(Year)
FILL IN YOUR Relationship to applicant
UNIVERSITY/
SCHOOL Profession or occupation and position
NAME ,
ADDRESS & Nationality and immigration status
PHONE NO.
Inviter in Japan(Please write 'same as above' if the inviting person and the guarantor are the same)
GUARANTOR / Name Tel.
INVITER
INFORMATION
NOT Address
REQUIRED IF
YOU ARE Date of birth Sex: Male Female
TRAVELING (Day)/(Month)/(Year)
TO JAPAN Relationship to applicant
FOR TOURISM
PURPOSE ON Profession or occupation and position
YOUR OWN
Nationality and immigration status
*Remarks/Special circumstances, if any
Have you ever:
● been convicted of a crime or offence in any country? Yes No
● been sentenced to imprisonment for 1 year or more in any country?** Yes No
PLEASE
TICK ● been deported or removed from Japan or any country for overstaying your visa or violating
THE any law or regulation? Yes No
APPROPRIATE
BOX ● been convicted and sentenced for a drug offence in any country in violation of law
concerning narcotics, marijuana, opium, stimulants or psychotropic substances?** Yes No
● 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? Yes No
● committed trafficking in persons or incited or aided another to commit such an offence? Yes No
** 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 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.”
FOR MINOR/ INFANT, PARENTS CAN SIGN ON BEHALF.
PLEASE WRITE DOWN NAME AND RELATIONSHIP.
Date of application Signature of applicant
(Day)/(Month)/(Year)
* It is not mandatory to complete these items.
Any personal information filled 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 to the extent necessary for the purpose of processing the visa application (including providing personal
information to the transportation company which you intend to board, or the alternative airline or ship which you initially did not
intend to board due to unforeseen circumstances) and for other purposes in compliance with Article 8 of the Act.