マーキュリー日本語学院 Mercury Japanese Language Institute ver.

List of documents to be submitted

Mercury Japanese Language Institute

(Documents to be prepa
bysupporter
①If the applicant (student) is the financial the reimburser)
☑ No Required Documents Notes ☑tra
Form prescribed by the school (to be filled out by
1 expense account（Form-4）
the person paying the expenses)
1、To the Minister of Justice

the Principal of the school

2 Two letters of reference（Form-2、6）
（To be filled out and signed by the person payin
expenses）
3 certificate of bank balance Original

Please specify your department, position, and

4 ｖcertificate of employment
tenure.
Tax certificates showing the amount of income
5 certificate of income
(for the past three years)
In the case that the financial supporter is a private
business owner only, the university will keep it during
Business license (original)、and tax
6 the examination by the Immigration Bureau, and
certificates (for the past three years)
return it to the individual after the examination results
are completed.

②If the controlling party is located in a country other than Japan

☑ No Required Documents Notes ☑tra

Form prescribed by the school (to be filled out by
1 expense account（Form-4）
the person paying the expenses)
1、To the Minister of Justice

the Principal of the school

2 Two letters of reference（Form-2、6）

（To be filled out and signed by the person payin

expenses）
Materials to prove the relationship with Birth certificate, notarized certificate of kinship,
3
the applicant etc.

4 certificate of bank balance Original tra

Explanatory notes and materials on the A copy of the bank book or any other material that
5 fund formation process clarifies the history of asset formation in 4.
tra

1、Company Employee Certificate of Employment

6 Documents proving occupation tra

(Please specify your

department, position, and length of service.
7 certificate of income Past 3 years divided

8 Copy of National Identity Card Double-sided copy

 8 Copy of National Identity Card Double-sided copy

③If the payer is a resident of Japan

☑ No Required Documents Notes ☑tra

Form prescribed by the school (to be filled out by
1 expense account（Form-4）
the person paying the expenses)
1、To the Minister of Justice

the Principal of the school

2 Two letters of reference（Form-2、6）

（To be filled out and signed by the person payin

expenses）
Materials to prove the relationship with Birth certificate, notarized certificate of kinship,
3
the applicant etc.

4 certificate of bank balance Original

Explanatory notes and materials on the A copy of the bank book or any other material that
5
fund formation process clarifies the history of asset formation in 4.
1、Company Employee Certificate of Employment
6 Documents proving occupation

(Please specify your department, position, and leng

7 certificate of residence All members of the household

8 Certificate of income and taxation A statement of annual gross income for the past three y

・The date of issue and issuer must be indicated on all certificates.

・All foreign documents should be accompanied by
Japanese translation.

・All copies must include the date the copy was made, the person who made it, and their relationship t
applicant.
・If it has been more than 5 years since the last school graduation, attach a separate sh
paper with the specific purpose of Japanese language study and career path.

・
ubmitted
Language Institute

(Documents to be prepared
reimburser)
☑translation

translation
o the Minister of Justice
2、To
Principal of the school

（To be filled out and signed by the person paying the

enses）
translation

translation

translation

translation

than Japan

☑translation

translation
o the Minister of Justice
2、To
Principal of the school

（To be filled out and signed by the person paying the

enses）
translation

translation

translation

translation

translation

ble-sided copy
ble-sided copy

☑translation

translation
o the Minister of Justice
2、To
Principal of the school

（To be filled out and signed by the person paying the

enses）
translation

translation

translation

mpany Employee Certificate of Employment

(Please specify your department, position, and length of

All members of the household

atement of annual gross income for the past three years

l certificates.
・All foreign documents should be accompanied by a

de, the person who made it, and their relationship to the

nce the last school graduation, attach a separate sheet of

study and career path.

・In
マーキュリー日本語学院 Mercury Japanese Language Institute ver.1 書式 Form

経費支弁書
Statement of Financial Responsibility
日本国法務大臣 殿
To Japanese Minister of Justice

申請者（学生） 氏 名 ： 国籍：
Applicant(Student) Full name Nationality

生年月日 ： 年 月 日生
Date of birth Year Month Day
私は、上記の者の日本国滞在経費支弁を誓約します。
I hereby pledge that I will take responsibility for payment of above named applicant's expenses.
また、上記の者が在留期間更新許可申請を行う際には、送金証明書または本人名義の預金通帳(送金事実、
経費支弁事実が記載されたもの）の写し等で、生活費等の支弁事実を明らかにする書類を提出します。
経費支弁が困難となった場合には、責任を持って速やかに帰国させます。
Moreover when applicant applies for visa extension. I will submit documents as evidence of payment such as a remitta
or the applicant's bank statement. In case any financial problem occurs, I will force applicant to return to their home co

1、経費支弁の引受経緯：（引受経緯及び申請者との関係について具体的に記載してください。）
Please explain your relationship to the above named applicant, and the reasons why you take financial responsibility.

2、経費支弁内容 Contents
(1) 学費 Tuition fee 半年6month / 年間1year

(2) 生活費 Living expenses 月額 Monthly

(3) 支弁方法 ：（振込など支弁事実の証明はビザ更新時に必要となります。）

Method of payment (Proof of payment should be submitted for visa extension)

(4) 在日親族と 同居 Living with Japan-based relative / 不同居 Not living with relative

(5) 申請者がアルバイトにて生活費の一部を負担する場合 If the applicant will work part-time.

週 時間 月 円程度の予定
Scheduled working hours per week＿hrs. Scheduled income per month about＿yen.
氏名 続柄
Full Name Relationship
現住所 電話番号
Present Address Home Phone
勤務先 職業
Name of Company Occupation
勤務先住所 電話番号
Company Address Office Phone

上記の通り相違ありません。 I hereby declare the above to be true and acurate.

署名（経費支弁者）
Signature(Sponsor)： 日付Date： 年Year 月Mon
 書式 Form-4

経費支弁書
of Financial Responsibility

t of above named applicant's expenses.

提出します。

l submit documents as evidence of payment such as a remittance certificate,

problem occurs, I will force applicant to return to their home contry immediately

plicant, and the reasons why you take financial responsibility.

円yen
円yen

Not living with relative

If the applicant will work part-time.

re the above to be true and acurate.

年Year 月Month 日Day
マーキュリー日本語学院 Mercury Japanese Language Institute ver.1 書式 Form

マーキュリー日本語学院
Mercury Japanese Language Institute
入学保証書（兼学校連絡票）
PAYMENT GUARANTEE(COMMUNICATION LIST OF SCHOOL)

マーキュリー日本語学院
校長 唐川 靖弘 殿
TO THE PRINCIPAL YASUHIRO KARAKAWA

保証人（父親/母親）
GURANTOR(FATHER/MOTHER)

父親の氏名： 印 母親の氏名：
FATHER'S NAME SEAL FATHER'S NAME

生年月日 ： 年 月 日 生年月日 ： 年 月
DATE OF BIRTH YEAR MONTH DAY DATE OF BIRTH YEAR MONTH
自宅住所 ： 自宅住所 ：
HOME ADDRESS HOME ADDRESS

TEL ： TEL ：
職業 ： 職業 ：
OCCUPATION OCCUPATION

会社名 ： 会社名 ：
COMPANY NAME COMPANY NAME
TEL ： TEL ：
会社住所 ： 会社住所 ：
ADDRESS OF ADDRESS OF
COMPANY COMPANY

年収 ： 年収 ：
ANNUAL INCOME ANNUAL INCOME

学生氏名： 男 女 生年月日 ： 年 月
STUDENT'S NAME M/F DATE OF BIRTH YEAR MONTH

国籍 ：
NATIONALITY

上記の学生が、貴校に入学を許可された場合には、本人の在日中に私が保証人として、下記の事項に対して全責任を持ち、保証することをここに誓約します。

1：貴校在学中の学費と滞在諸経費並びに必要時に於ける帰国旅費の負担。
2：学生が貴校の学校規則並びに日本国の法律を遵守すること。
3：貴校の学業終了後に進学しない場合は責任を持って学生を帰国させること。
I hereby pledge myself to take all the responsibility for the following as a guarantor during his/her stay in Japan, when a student
permitted admission to your school.
1：I am responsible for his/her academic fees, expenses for his/her stay and return.
2：The student must obey school rules and the law of Japan.
3：The student must return home when he/she doesn't go to higher education after graduation.
(注意)経費支弁者が必ず保証人になること。経費支弁者は職業（会社名・住所）、年収の記録が必要となります。
原則として父親か母親がなること。
A guarantor should go security for a student. A guarantor should have a recordeing of occupation (name and address of compan
A suitable person for guarantor is his/her father/mother as a general rule.
書式 Form-6

印
SEAL

日
DAY

日
DAY

a student is

of company).