Japan COVID-19 ¥100,000 Payment Application Form – English Translation

May 28th Update: Tokyo 23 Ward Application and Payment Schedule – This post summarizes the approximate date when applications were (or will be mailed out) and when to expect payment.

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April 28th Update: Where to download a PDF of the paper application form for the ¥100,000 payment.

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In this article we provide a translation of the draft application form for the ¥100,000 special “fixed benefit” payment that will be provided to every resident of Japan who has a Residence Card.

The draft was released on April 20th by the Ministry of Internal Affairs for use as a template by municipal governments.

Local governments are still in the preparation stages of sending out application forms to residents. Please be aware that the final application form may differ from the one translated below.

How do I apply?

1. By Postal Mail

  1. Your municipal government office will mail the application to you at the address on your Residence Card.
  2. Fill in the application form and and attach proof-of identity/bank account documents.
  3. Mail the form back to your municipal government office.

Scroll below for an explanation and translation of the ¥100,000 application form.

2. Apply online through My Number Portal

If you have a My Number Card, you can also apply to receive the payment online through the My Number Portal.

The Ministry has not indicated whether the link is live yet for online applications. When it goes live, you can log into your account to apply and upload your documents through the My Number Portal.

Am I eligible to receive the payment?

Please see this article for details on eligibility and other FAQs on the special payment

Updated details on Japan’s COVID-19 ¥100,000 payment to all residents of Japan


Translation Cheat Sheet for Application Form

In the translation below, the original Japanese is shown in bold, English translation follows this mark ==>, and explanatory notes follow, as necessary.

The draft application form looks like this:

Draft of application form for ¥100,000 “special fixed-amount” payment (front). Source: Ministry of Internal Affairs

Draft of application form for ¥100,000 “special fixed-amount” payment (back). Source: Ministry of Internal Affairs

Explanatory Text

At the top of the form is some explanatory text. There’s nothing you have to fill in here.

<特別定額給付金の申請は、本申請書の郵送のほか、マイナポータル上でのオンライン申請も可能です>

==> To apply for the “fixed benefit payment” you can mail in this application or apply online via the “My Number Portal” site.

特別定額給付金申請書

==> Fixed Benefit Application

To the upper-right of the form

Rectangle: 現時点での 様式(案)

==> Current application form format (draft)

Notes: This is a note indicating that the form is a draft (so the final format may change!)

Circle: 市区町村 受付印

==> Municipality reception stamp

Notes: Nothing for you to do here! This is where your local government office will stamp your application to indicate that they’ve received it.

1. Fill in head of household info

To the upper-left of the form:

申請日

==> Application Date

Notes: Fill in the white box with the application date in Japanese date format, starting with the year (use the number “2” for year because it’s the second year of the Reiwa period, then month, and day).

令和2年4月27日時点の住民票所在市区町村

==> The municipality (city, ward, town, village) you reside in as of April 27, 2020.

Notes: Fill in the white box with the name of the municipality indicated on your Residence Card as of April 27, 2020.

世帯主(申請・受給者)

==> Head of household (Applicant/Person receiving payment)

Notes: In this section, fill in the “head of household” information. This is the person to whom the payment will be made. Also, write the furigana (the katakana or hiragana pronunciation of your name).

氏名

==> Full Name

Notes: Write your full name in the white box.

==> Stamp Here

Notes: If you have a hanko (seal), stamp here! You can also sign your name over the mark.

生年月日

==> Birthdate

Notes: Fill in the birthdate of the Head of Household using Japanese date format.

現住所

==> Current address

日中に連絡可能な電話番号

==> Phone number where you can be reached during the day.

Notes: Fill in your current address and phone number in the white space.


2. Agree to the following

==> I am applying for the special fixed-benefit payment and agree to the following:

  1. The municipal government may check public records in order to confirm your eligibility to receive the payment.
  2. If the municipal government cannot confirm your eligibility, you may be required to submit other relevant documents as part of your application.
  3. If the municipal government is not able to complete the transfer of funds to your designated bank account (for example, due to an error you made filling out the form) or the municipal government is not able to confirm the eligibility of the applicant (or designated representative of the applicant) within  three months of the starting date for the receipt of applications, your application will be considered as withdrawn.
  4. If you receive a special fixed-benefit payment from another municipality, you will have to return it.

3. Check recipient information

給付対象者(下記の記載内容を御確認ください。 もし記載に誤りがあれば、朱書きで訂正してください)

==> Recipients (Please check the info below. If there is an error, please correct it in red.)

Notes: The full names of everyone in your household, their relationship to you, and their birthdates will be pre-printed on the form. In the screenshot above, Rows 1, 2, and 3 are pre-printed  with sample information for “Taro Chiyoda,” his wife and child.

  • 世帯主: Head of household
  • 妻: Wife
  • 子: Child

Check the recipient information for yourself, the members of your household (if any), and make any corrections with a red pen.

合計金額

==> Total Amount

Notes: The total amount that will be paid to you and any members of your household will be pre-printed here, at ¥100,000 per person.

Next, to the right of the Recipient information box is another box where you can indicate if the person does NOT want to receive the special benefit payment.

特別定額給付金を希望されな い方につきましては、以下の チェック欄(□)に×印を御記 入ください。

==> If you do not wish to receive the special fixed benefit, please enter an X in the check box (□) below.

Notes: If you or any member of your household do NOT want to receive the payment, just check the box in the relevant row.


4. Fill in your bank account information

 

○ 受取方法 (希望する受取方法(下記のA又はB)のチェック欄(□)に『✔』を入れて、必要事項を御記入ください。)

4.1 Check Box A or B to select how you would like to receive payment

Check Box A or B below to indicate how you would like to receive payment and fill in the required information.

□ A 指定の金融機関口座(申請・受給者又はその代理人の口座に限ります。)への振込を希望

Check Box A: Transfer to designated financial institution account. You can only designate the bank account of the applicant (head of household) or a designated agent.

□ この口座が当市区町村の水道料、地方税等の引落し又は払込みに現に使用している口座であって、申請・受給者の名義で
ある場合(この場合は通帳やキャッシュカードのコピーを添付する必要はありません。) また、当該口座の確認について、水道部局、税部局等に照会を行うことを承諾します。

Check this box if the bank account you designate is in the name of the applicant (head of household) and is also the same account that is used to make automatic withdrawals to pay your water/sewage bill, to pay your local inhabitant’s tax, etc. If this is the case, you do NOT need to attach a copy of your cash card (ATM card) as part of this application. In addition, you also give consent for the municipal government to check with the water bureau, tax bureau, etc. to confirm that the designated account is your account.

Below, also check the relevant box to indicate which of the following applies to the account you designate:

(希望する口座) □ 水道料引落口座   □ 住民税等の引落口座   □ 児童手当受給口座

Requested Account

  • Water/sewage automatic withdrawal account
  • Local inhabitant’s tax automatic withdrawal account
  • Account where child allowance is received

If you selected Box A to receive your payment, this is the section where you fill in your financial institution account information.

4.1.1 For all bank accounts other than Japan Post Bank

The top box is for all bank accounts other than Yucho (Post Office) bank accounts. Obviously, if you want to designate a Yucho Bank account, skip the top box and fill in the bottom box only.

Circle your financial institution type:

  1. 銀行: Bank
  2. 金庫: Deposit bank
  3. 信組: Community bank
  4. 信連: JA Bank
  5. 農協: Agricultural Cooperative
  6. 漁協: Fisheries Cooperative
  7. 信漁連: Marine bank

支店名

==> Branch Name

Notes: Fill in the name of bank branch name in the white box. This can be found in your account passbook.

Circle the branch type:

  • 本店: Main office
  • 支店: Branch office
  • 本所: Main office
  • 支所: Branch office
  • 出張所: Branch office

支店コード

==> Branch Code

Notes: Fill in the 3-digit branch code of your bank here. This can be found in your account passbook.

口座番号 (右詰めでお書きください。)

==> Bank Account Number (Fill in the squares, right-justified)

Notes: Fill in your account number. Some bank accounts numbers have 7-digits, some have fewer. If your account number is 6-digits, for example, leave the left-most square blank.

口座名義

==> Account Holder

Notes: Fill in the Account Holder name of your bank account. Also, write the furigana (the katakana or hiragana pronunciation of your name).

4.1.2 Japan Post Bank

ゆうちょ銀行を選択された場合は、貯金 通帳の見開き左上またはキャッシュカー ドに記載された記号・番号をお書きくださ い。

==> If you choose Japan Post Bank, write the symbol or number that appears at the top left of your open bank book or on your cash card.

通帳記号 (6桁目がある場合は、※欄 に御記入ください。)

==> Passbook symbol (If there is a sixth digit, please fill in the * column.)

通帳番号 (右詰めでお書きください)

==> Passbook number (Fill in the squares, right-justified).

Notes: If your account number is less than 8-digits, leave the left-most square(s) blank.

4.2.2 If you Check Box B

□ B 申請書を窓口で提出し、後日、給付(申請書の返送の必要はありません。) (金融機関の口座がない方や金融機関から著しく離れた場所に住んでいる方が対象となります。)

==>   □ B Submit the application form at the (city/ward/town office) counter and receive your payment at a later date. (You do not need to return the application form.)

(For those who do not have a financial institution account or who live significantly far away from their financial institution. )

Notes: As the instructions say, check Box B if you don’t have a bank account or can’t easily go to your bank to withdraw payment from your account. In this case, payment will be made to you in cash at your municipal government office, at a later date.


5. If you wish to designate a proxy (representative) to act on your behalf

【代理申請(受給)を行う場合】

==> If you’re applying to have a representative to act on your behalf.

Notes: You only have to fill in this section if you would like someone else to apply on your behalf or to receive the payment on your behalf.

In this section fill in your proxy’s personal information.

代理人氏名

==> Full name of proxy.

代理人生年月日

==> Birthdate of proxy in Japanese date format.

代理人住所

==> Address of proxy.

日中に連絡可能な電話番号

==> Daytime phone number of proxy.

上記の者を代理人と認め、特別定額給付金の ______ を委任します。

==> I hereby designate the above-mentioned person to be my agent in order to _________.

Notes: Circle one of the three options in the brackets:

  • 申請・請求:  Apply / request
  • 受給:  Receive payment

  • 申請・請求及び受給:  Apply / request and receive payment

     

 

世帯主氏名

==> Full name of head of household.

Notes: If you wish to designate a proxy, write your full name here.

==> Stamp Here

Notes: If you have a hanko (seal), stamp here! You can also sign your name over the mark.


6. Attach copies of ID and Bank Account docs

On the back of the form, in the rectangles, paste paper copies of

  1. Top rectangle: Document showing proof of identity of the applicant
  2. Bottom rectangle: Document verifying the bank account where you would like to receive payment

7. Mail completed application to your municipal government office