所属機関等作成用２　U（その他） For organization, part 2 U (Others) 在留期間更新・在留資格変更用 For extension or change of status
(11)雇用主の同居家族（父・母・配偶者・子など）
Employer's family (Father, Mother, Spouse, Son and Daughter, etc.)
続柄
Relationship		 氏名
Name		 生年月日
Date of birth		 国籍・地域
Nationality		 同居の有無
Residing with applicant or not		 勤務先名称・通学先名称
Place of employment / school		 在留資格
Status of residence

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No
10　扶養者（申請人が扶養を受ける場合に記入） Supporter (Fill in the followings when the applicant is to be supported)
(1) 氏名 Name
(2) 生年月日 Date of birth 年 Year 月 Month 日 Day (3) 国籍・地域 Nationality / region
(4) 在留カード番号 Residence card number (5) 在留資格 Status of residence
(6) 在留期間 Period of stay (7) 在留期間の満了日 Date of expiration 年 Year 月 Month 日 Day
(8) 申請人との関係（続柄） Relationship with the applicant supporter_relation_husband ?? '') == '1' ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 夫
Husband supporter_relation_wife ?? '') == '1' ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 妻
Wife supporter_relation_father ?? '') == '1' ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 父
Father supporter_relation_mother ?? '') == '1' ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 母
Mother supporter_relation_foster_father ?? '') == '1' ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 養父
Foster father supporter_relation_foster_mother ?? '') == '1' ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> 養母
Foster mother supporter_relation_other ?? '') == '1' ? 'checked' : '' }} {{ $type == 'detail' ? 'disabled' : '' }}> その他（）
Others
(9) 勤務先名称 Place of employment 支店・事業所名 Name of branch
(10) 法人番号（13桁） Corporation no. (combination of 13 numbers and letters)
(11) 雇用保険適用事業所番号（11桁）※非該当事業所は記入省略 Employment insurance application office number (11 digits) *If not applicable, it should be omitted.
-
(12) 勤務先所在地 Address 電話番号 Telephone No.
(13) 年収（扶養者が「外交」又は「公用」の場合は記入不要） Annual income (when the supporter has the status of residence "Diplomat" or "Official", there is no need to fill this in.) 円 Yen
11　日系四世受入れサポーター（同サポーターが個人の場合に記入） Supporter accepting the fourth-generation foreign national of Japanese descent
(Fill in the following items if the supporter accepting the fourth-generation foreign national of Japanese descent is an individual)
(1) 氏名
Name
(3) 国籍・地域
Nationality / region
(2) 生年月日
Date of birth
年 月 日
(4) 在留カード番号
Residence card number
(5) 在留資格
Status of residence
(6) 申請人との関係
Relationship with the applicant
(7) 住所
Address
(8) 電話番号
Telephone no.
12　日系四世受入れサポーター（団体の場合に記入） Supporter accepting fourth-generation foreign national of Japanese descent
(Fill in the following items if the supporter accepting the fourth-generation foreign national of Japanese descent is an organization)
(1) 団体名称
Name of organization
(2) 事業所名
Name of branch
(3) 所在地
Address
(4) 電話番号
Telephone No.
以上の記載内容は事実と相違ありません。
所属機関等契約先の名称又は日系四世受入れサポーター（法人名）、代表者氏名の記名／申請書作成年月日
Name of the organization the contracting organization such as the organization of affiliation or supporter accepting the fourth-generation foreign national of Japanese descent (organization), and its representative of the organization／Date of filling in this form
扶養者、身元保証人又は日系四世受入れサポーター（個人）の署名／申請書作成年月日
Signature of the supporter, guarantor, or supporter accepting the fourth-generation national of Japanese descent (individual) form／Date of filling in this form

Year Month Day
注意
申請書作成後申請までに記載内容に変更が生じた場合、所属機関等又は扶養者等が変更箇所を訂正すること。
In cases where descriptions have changed after filling in this application form up until submission of this application, the organization must correct the changed part.