官報号外第111号（令和7年5月21日）および関連様式
令和7年5月21日|p.84
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令和7年5月21日水曜日官報(号外第111号)84
3. Person who is considered to have done a removal or retention of the child
English
Last name
Middle name (if any)
First name
Name
Japanese
(Chinese
character,
if possible)
Other
(if any)
language
Alias (if any)
Last name
Language
Last name
Date of birth
Day
First name
Last name
Middle name (if any)
First name
First name
Month
Year
Nationality
Relation with the child
Place of birth
(if Japanese, registered
domicile)
(if known)
Domicile or residence
Father
□ Father
Country
Country
Mother
□□
Address
Address
Telephone no.
Mobile
telephone no.
Fax no.
E-mail address
Country code
+(
Country code
+(
Country code
+(
(0)
(0)
) - (0)
Passport
(Please provide information
of all passports possessed.)
Issuing country
Height
No.
Weight
Description
Other
Occupation
Other (
□□
(9
--
Color of hair
Expiry date
Day
Month Year
11
11
Color of eyes
11
Claim of domestic
violence
Living with the
child
This person is claiming or might claim to be a victim of domestic violence.
This person is not claiming and will not claim to be a victim of domestic violence.
This person does not live together with the child.
This person lives or may live together with the child.
e.g.: Persons who might be able to provide addition:al information (name, address, telephone no., e-mail
address, relation with this person), place of work, etc.
identify the
whereabouts
Other useful
information to