様式第四(第四条関係) - Child Contact Assistance Application
令和7年5月21日|p.96
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様式第四(第四条関係)
Application for Assistance in Contact with Child
《Note》
Before completing this form, please read the Guide to making an Application for Assistance in
Contact with Child' and follow the instructions.
> Please provide as much information as possible.
Please indicate Z in the appropriate boxes.
1. Applicant
English
Last name
Middle name (if any)
First name
Name
Other
(if any)
language
Japanese
(Chinese
if possible)
character,
Date of birth
Last name
Language
Day
Last name
Month
First name
Middle name (if any)
First name
Year
Nationality
Relation with the child
Domicile
or residence
□ Father
Country
□Mother
Address
Occupation
Other (
□□
11
Telephone no.
Mobile
telephone no.
Fax no.
Country code
+(
Country code
+(
Country code
+(
(0)
(0)
(0)
--
11
--
1.
10
--
E-mail address
(3
Identity card
Type of identity card
Issuing country and organization
No.
Expiry date
Day
Year
Month Year
11
11
plication)
adviser (if you are
Details of a legal
English
Last name
Middle name (if any)
First name
Name
Japanese
(Chinese
character,
if possible)
Location of office
Last Name
Country
Address
First Name
Telephone no.
Fax no.
E-mail address
License
person with the
Preferred contact
Central Authority
Country code
+(
Country code
+(
) - (0)
) - (0)
Country
Type of license
11
--
(3)
□ This legal adviser
□ Applicant
10
--
□ Either one will be fine