Permanent Residence Application Form

Photo

40mm × 30mm, taken within 6 months. Do not staple.

Q1–10: Basic Personal Information

Name must match your passport exactly.

Q11–12: Residence Status & Card

Must match your Resident Card.

Q13: Criminal Record

If you have ever been subject to disciplinary action on criminal grounds, please provide specific details of the offence and the nature of the disciplinary action, etc.

Q14: Reason for Applying

A short explanation for why you want to apply for PR.

Q15: Past Entry Under Different Identity

If you have ever entered or left the country using personal details that differ from those entered in Q1 to Q3, please select 'Yes' and provide the relevant details.

Q16: Personal History

Attach a separate sheet if the space is not enough.

Q17–18: Main Householder & Family in Japan

If you support yourself, select 'Self' for Q17. Q18 must include everyone you live with, not just immediate family.

Q19: Guarantor in Japan

Must be a Japanese national or permanent resident living in Japan.

Q20: Legal Representative

Only fill in if a legal representative is submitting the application on your behalf — leave blank if you are applying yourself.

Signature & Date

Sign and date on the day of submission. Any corrections made after writing must be initialled.

Agent or Authorized Person

Only fill in if someone other than you or your legal representative (e.g. a registered immigration lawyer) is submitting the form on your behalf.