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Year

Month

Day

Date

Application for Japanese-Language Proficiency Test Certificate of Result and Scores


I hereby request a Japanese-Language Proficiency Test Certificate of Result and Scores, the official test certificate and notice of results. Name
in Roman alphabet

Date of birth Test year

Year

Month

Day

For those who took the test in 2009 or earlier; Registration number Test level Level 1 Level 2 Level 3 Level 4 Circle one

For those who took the test in 2010 and after; Registration number Test level Test location N Country N2 N3 N4 City N5 Circle one

Mailing address
If this address is outside of Japan, please use Roman alphabet Zip/Postal code Country

Telephone number E-mail address Remarks If you do not remember your registration number, please be sure to fill in Test year, Test level, and Test location. Please fax a photocopy of your proof of identification (copy of your passport is preferred) along with this application. If the name on your proof of identification is written in Kanji , be sure to write your name both in

Kanji and Roman alphabet in box Name above.


You must add a letter of proxy if a friend, teacher, or colleague is filling this application for you. FAX to: The Japan Foundation Center for Japanese-Language Testing From outside Japan +81-3-5367-1025 From within Japan 03-5367-1025

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