官報号外第11号（合和7年5月21日）および関連書類のブロック
令和7年5月21日|p.86
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合和7年5月21日水曜日官報(号外第11号)86
5. Person who is considered to live together with the child
is considered to have done a removal or retention of the child (indicated in 3).
*Please provide information about a person who possibly lives together with the child besides the person who
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
Last name
First name
Middle name (if any)
First name
First name
Month
Year
Nationality
Relation with the child
Place of birth
(if Japanese, registered
domicile)
□ Father
Country
residence
Domicile or
Country
□□
Mother
Address
Address
Telephone no.
Mobile
telephone no.
Fax no.
E-mail address
Passport
(Please provide information
of all passports possessed.)
Country code
+(
Country code
+(
Country code
+(
) - (0)
) - (0)
) - (0)
Issuing country
No.
Height
Weight
Description
Other
Occupation
□ Other (
11
10
--
000
11
1-
(9
10
Color of hair
Day
Expiry date
11
11
Month Year
1 1
Year
Color of eyes
Claim of domestic
violence
identify the
whereabouts
Other useful
information to
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.
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.