再入国関連書類提出確認書交付申請書

APPLICATION FORM FOR LETTER OF CONFIRMATION

OF SUBMITTING REQUIRED DOCUMENTATION
FOR RE-ENTRY INTO JAPAN

Page
Surname (as shown in passport)_________________________________________________________
Alexander
Given and middle names (as shown in passport)__________________________________________
Other names (including any other names you are or have been known by)
________________________________________________________________________________
21 08 1990
Date of birth______/_____/________ London, UK
Place of birth__________________________________
Day /Month /Year
Sex: Male□
✔ Female□
British
Nationality or citizenship_____________________________________________________________
Address in Japan_______________________________________________________________________

516084424
Passport Number__________________________ 28 April 2013
Date of issue___________________________
UK
Place of issue___________________________ 28 April 2023
Date of expiration______________________

Type of status of residence: Specialist in Humanities/International Services

3 Years
Period of stay____________________________ 15th November 2021
Date of expiration_______________________
PN16222916EA
Residence card number_____________________

24th December 2020

Date of expiration of re-entry permit_______________________________

Date of re-entry_____________ (Air)Port in Japan________________ Flight no.___________

Tel. 07984025004 Mobile No. E-Mail alex.page28@gmail.com

I hereby declare that the statement given above is true and correct.

Signature_________________________________________ 13 08 1990
Date______/_____/________
Day /Month /Year