Application forms

Download the appropriate application form.

Forms used by staff responsible

Form	Example
Notification of Eligibility as Insured Person	－
Notification of Loss of Eligibility as Insured Person Notification of Loss of Eligibility as Insured Person	Example
Insured person category change notice	－
Notice of employment at two or more establishments Notice of employment at two or more establishments	Example
Application for maternity leave (before/after childbirth) Application for maternity leave (before/after childbirth)	Example (1) Example (2) Example (3) Example (4) Example (5)
Application for childcare leave (new/extended) Application for childcare leave (new/extended)	－
Notice of change to monthly remuneration of insured person Notice of change to monthly remuneration of insured person	Example
Notice of change to monthly remuneration of insured person upon end of maternity leave Notice of change to monthly remuneration of insured person upon end of maternity leave	Example
Notice of change to monthly remuneration of insured person upon end of childcare leave Notice of change to monthly remuneration of insured person upon end of childcare leave	－
Notice of basis for calculating standard monthly remuneration of insured person Notice of basis for calculating standard monthly remuneration of insured person	Example
Notice of basis for calculating standard monthly remuneration of insured person: Summary sheet Notice of basis for calculating standard monthly remuneration of insured person: Summary sheet	Example
Application for calculating annual remuneration using averaging	－
Insurer calculation application, comparison of standard monthly remuneration, consent of insured person, etc.	Example
Notice of bonus payment to insured person Notice of bonus payment to insured person	Example
Notice of bonus payment to insured person: Summary sheet	Example
Notification of Long-term Care Insurance (Qualification/Disqualification) Notification of Long-term Care Insurance (Qualification/Disqualification)	Example
Notification of Health Insurance Card Nonrecoverable Notification of Health Insurance Card Nonrecoverable	－

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