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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