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Documents required when applying for dependent certification

※ Documents to be submitted: Group HR & Administrative Service Department Social Insurance in charge(ELO)

★: Must be submitted in all cases.
☆: Must be attached for applicable persons.
* It takes at least two weeks to issue a health insurance card.

Relationship Lives together with/separately from insured person Notification of Health Insurance Dependent (Change) Application form Passport (copy) Income confirmation documents Income certificate/taxation (tax exemption) certificate Certificate of separation Certificate of eligibility for employment insurance benefits (copies of both sides) Certificate of school attendance Certificate of residence (for all members of the household) Report of allowance amount Certificate of remittance Exempt from domestic residency requirement
May apply even if not living together with insured person
Spouse Toge
ther

Form 1

Note 1

Note 2

Note 5

Note 6

Note 7

Note 10
Sepa
rately

Form 1

Note 1

Note 2

Note 5

Note 6

Note 7

Note 8

Note 9

Note 10
Child by blood New
born
Toge
ther

Note 1

Note 3

Note 10
Student (through junior high school)
Form 2

Note 1

Note 3

Note 8

Note 10
Student (high school, college, various professional or preparatory schools)
Form 2

Note 1

Note 3

Note 7

Note 8

Note 10
Non-student
Form 2

Note 1

Note 2・3

Note 4

Note 5

Note 6

Note 8

Note 10
New
born
Sepa
rately

Note 1

Note 3

Note 9

Note 10
Student (through junior high school)
Form 2

Note 1

Note 3

Note 8

Note 9

Note 10
Student (high school, college, various professional or preparatory schools)
Form 2

Note 1

Note 3

Note 7

Note 8

Note 9

Note 10
Non-student
Form 2

Note 1

Note 2・3

Note 4

Note 5

Note 6

Note 8

Note 9

Note 10
Parent Toge
ther

Form 3

Note 1

Note 2

Note 4

Note 5

Note 6

Note 7

Note 8

Note 10
Sepa
rately

Form 3

Note 1

Note 2

Note 4

Note 5

Note 6

Note 7

Note 8

Note 9

Note 10
Sibling Toge
ther

Form 3

Note 1

Note 2

Note 4

Note 5

Note 6

Note 7

Note 8

Note 10
Sepa
rately

Form 3

Note 1

Note 2

Note 4

Note 5

Note 6

Note 7

Note 8

Note 9

Note 10
Must live together with insured person
Parent
in law
Toge
ther

Form 3

Note 1

Note 2

Note 4

Note 5

Note 6

Note 7

Note 8

Note 10
Nephew/
niece
Toge
ther

Form 3

Note 1

Note 2

Note 4

Note 5

Note 6

Note 7

Note 8

Note 10
Uncle/
Aunt
Toge
ther

Form 3

Note 1

Note 2

Note 4

Note 5

Note 6

Note 7

Note 8

Note 10
1. Documents indicated by a black star (★) are mandatory.
2. Attach documents indicated by a white star (☆) only if applicable. Check the notes below before submitting these documents.
Note 1: For a family member with non-Japanese nationality, submit a photocopy of the name page of his or her passport.
Note 2: For a family member with an income, submit documents that can be used to confirm the amount of his or her income.

Salary Pay statements for most recent three months (copies)
* If the dependent family will work less than 108,334 yen (including pre-deduction, transportation cost, bonus) per month in future,please submit the employer's certificate (employment contract, etc.)
Pensions Most recent pension amendment notice (copy) or pension payment notice (copy)
* For all pensions received, including old-age, corporate, survivor’s, and disability pensions
Compensation during leave Notice of payment of maternity allowance/injury and sickness allowance (copy)
Other Income tax return and income statement (Blue Return financial statements) with "Received" seal of tax office affixed (copy)
Note 3: If the family member is a dependent of both spouses (i.e., a child of parents who both work), submit certificates of income and withholding tax for both spouses or other documents that can be used to confirm their incomes.
Not required if both spouses are members of the Suntory Health Insurance Association
Note 4: Have this document issued by the municipality in which your certificate of residence is on file.
Note 5: When applying for dependent certification of a family member because he or she is no longer employed, attach any of the following documents to verify the date on which employment ended (photocopies are acceptable): Certificate of loss of health insurance eligibility, retirement certificate, separation slip, certificate of eligibility for employment insurance benefits, certificate of income and withholding tax showing date on which employment ended. If the family member has ceased self-employment, submit a notice of cessation of business with the "Received" seal of tax office affixed.
Note 6: When applying for dependent certification of a family member because he or she no longer receives employment insurance benefits, submit copies of both sides of the certificate of eligibility for employment insurance benefits.
Note 7: When applying for dependent certification of a family member who is a student, submit a certificate of school attendance or a copy of his or her student ID or student pass.
Note 8: Submit a certificate of residence that does not show individual numbers ("My Number") but does show familial relationships for all household members, including the individual for whom the application for health insurance dependent certification is being submitted.
In the case of an adopted child, to confirm the fact of adoption, this document must be submitted even if the child lives with the insured person.
This does not apply if the individual for whom the application for dependent certification is being submitted is a family member who remains at home (and who is supported by the insured person) at a time when the insured person is on an unaccompanied job posting.
Note 9: A certificate of remittance includes photocopies of remittance notices or photocopies of bank passbook pages showing the names of the remitter and the recipient of the remittance.Submit a certificate of remittance for the three most recent months (clearly showing who remitted the funds, who received them, remittance dates, and amounts remitted).
This does not apply if the individual for whom the application for dependent certification is being submitted is a family member who remains at home (and who is supported by the insured person) at a time the insured person is on an unaccompanied job posting or is a student in high school or a lower level of education who lives apart from the insured person to attend school
A certificate of remittance is required for a family member who lives with the insured person but is indicated on a separate certificate of residence (divided household). In such cases, the family member is regarded to live apart.
Note 10: If the family member has no address in Japan but qualifies for an exemption fromthe domestic residency requirement, submit the appropriate documentation in accordance with the reason for the exemption


Documents to attach for dependents who qualify for exceptions to the domestic residency requirement even though they do not have addresses in Japan

Reasons for exception Certifying documentation
(1) Student studying abroad Copy of visa, student ID, certificate of school attendance, certificate of school admission
(2) Family member accompanying an insured person posted abroad Copy of visa, written appointment overseas, certificate of residence issued by a foreign public agency, etc.
(3) Person traveling abroad temporarily for sightseeing, recreation, volunteer activities, or other reasons unrelated to employment Copy of visa, certificate of agency dispatched for volunteer activities, certificate of consent to participate in volunteer activities
(4) Person recognized as equivalent to (2) above due to family relationship to an insured person arising while the insured person is posted abroad Copy of documentation certifying birth, marriage, etc.
(5) In addition to (1)-(4) above, person recognized to have a livelihood based in Japan in consideration of purposes of traveling abroad and other circumstances Subject to determination on a case-by-case basis. Please contact the Health Insurance Society.
Note: If documents were prepared in a foreign language, please attach a Japanese translation signed by the translator.
 
3. If the family member subject to application for dependent certification is a person with a physical disability, submit a copy of his or her physical disability handbook. Additionally, if the family member receives a medical subsidy from his or her municipality, submit a copy of his or her medical certificate.
4. Depending on the application, you may also be asked to submit other documents.
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