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Notes on Filling Out the Form

Please fill out the required fields below and click the "Confirm" button. Items marked with (Required) must be completed.

  • * Please do not use half-width katakana.
  • * Our staff may contact you by phone or email to confirm your application details.

1. Enter Information

Preferred Plan (Required)

Type of Request (Required)

Full Name (Alphabet) (Required)

Name in Katakana (Required)

Nationality

Current Address (Prefecture / City)

Residence Card Expiration Date

Email Address (Required)

Phone Number (Required) *Mobile phone accepted

Inquiry Details / Requests (Required)

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