May I request to issue the copy of the immigrant record of Mr
REQUEST FOR ISSUANCE OF IMMIGRATION CARD COPY
I am a lineal (direct) descendant of Mr. / Ms. .
I understand that my request is not part of the Consulate’s official services and I realize that it may take days to process my request. I also understand that the Japanese Consulate does not provide translation services for these immigration cards or further help with genealogy research.
I am enclosing proof of relationship between the person named above and myself, (my birth certificate, my parents’ birth or marriage or death certificate, etc.) and a self-addressed stamped envelope.
□ Check this box if you need the municipal contact information in Japan. (for koseki tohon)
Pick one: □ results by e-mail or □ results sent by post (include self-addressed stamped envelope)
Your name: __________________________________________________
Address: ________________________________________________
________________________________________________
E-mail Address: ___________________________________________
Phone Number: ( )___________________________________
Relationship to the immigrant: ________________________________
Name & Date of Birth of the first immigrants of the family
*Husband’s name, wife’s name and child(ren)’s name must be given
** Please write their Japanese name in kanji as well and birthday/birth year. (If you know)
(Husband) ________________________________________________
(Wife) ___________________________________________________
(Child) ___________________________________________________
(Child) ___________________________________________________
(Child) ___________________________________________________
(Child) ___________________________________________________
( ) _________________________________________________
( ) _________________________________________________
Name of hometown in Japan _________________________Date of arrival (if known):
Date: Signature
Revised 3/2019
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