官報令和7年5月21日号（100頁）および関連様式
令和7年5月21日|p.100
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令和7年5月21日水曜日官報(号央111号)100
5. Person who is considered to live together with the child
is considered to be interfering with contact with 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
Last name
First name
Middle name (if any)
First name
First name
Date of birth
Day
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
of all passports possessed.)
(Please provide information
Country code
+(
Country code
+(
Country code
+(
(0)
) - (0)
(0)
Issuing country
No.
Height
Weight
Description
Other
Occupation
Other(
□□
11
10
1,
--
a
10
Color of hair
Expiry date
Year
Month
Day
11
11
Color of eyes
Claim of domestic
violence
identify the
Other useful
whereabouts
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.