Documents to submit when applying for dependent certification

The following documents must be submitted in addition to the Application Form for Dependent Certification. You may be asked to attach and submit documentation in addition to the documents indicated below.
Note that the Society may check with related institutions to confirm the documents attached.
Family member			Documents to attach (see application method for details)	Application form, application method (link)
Child (Whether living together or separately)		Newborn child	Maternal and child health handbook (copy of page certifying submission of birth notice) or Claim for Childbirth and Childcare Lump-sum Grant (if not using the system of direct payment of Childbirth and Childcare Lump-sum Grant to medical institutions)	Click here.
		Newborn child	(If both spouses work) Previous year’s certificate of income and withholding tax (copy) for both
		Student	Certificate of school attendance (not required for high school and lower grades)
			Certificate of residence (showing all residents of household and all family members)
			(If both spouses work) Previous year’s certificate of income and withholding tax (copy) for both
Living together	Child other than the above	Documents required in all cases: Survey Form of Livelihood Dependency on Insured Person Certificate of residence (indicating all residents of household, all family members, and relationship between all residents) Note: Submit an official copy of family register if the certificate of residence does not show relationship between all family members. Copy of most recent pension income certificate (notice of revision to pension amount, pension remittance notice, etc.) if receiving disability pension or other pension benefits		Click here.** Also click here if self-employed.
		Retired	Unemployment Benefits Receipt Confirmation Form If waiving unemployment benefits, also submit the Unemployment Benefits Waiver Confirmation Form.
		Retired	One of the following: Copy of pay statement for the most recent six months and retirement certificate or certificate of loss of eligibility for health insurance Employment insurance separation slips no. 1 and no. 2 (copies) Certificate of eligibility for employment insurance benefits (copy)
		Employed part-time	One of the following: Employment contract (copy), etc. Pay statement for the most recent three months (copy) and document indicating details of most recent bonus (copy) Note: If receiving income from a source other than part-time employment, also submit an income certificate.
		Unemployed	Income certificate
		Self-employed	Income certificate Copy of final income tax return Copy of income statement (profit and loss statement) Note: If the business has been discontinued, submit a notice of business discontinuation. (In such cases, there is no need to submit copies of the final income tax return, income statement, profit and loss statement.)
	Spouse	Documents required in all cases: Certificate of residence (indicating all residents of household, all family members, and relationship between all residents) Copy of most recent pension income certificate (notice of revision to pension amount, pension remittance notice, etc.) if receiving old age pension, disability pension, or other pension benefits		Click here.** Also click here if self-employed.
		Retired	Unemployment Benefits Receipt Confirmation Form If waiving unemployment benefits, also submit the Unemployment Benefits Waiver Confirmation Form.
		Retired	One of the following: Copy of pay statement for the most recent six months and retirement certificate or certificate of loss of eligibility for health insurance Employment insurance separation slips no. 1 and no. 2 (copies) Certificate of eligibility for employment insurance benefits (copy)
		Employed part-time	One of the following: Employment contract (copy), etc. Pay statement for the most recent three months (copy) and document indicating details of most recent bonus (copy) Note: If receiving income from a source other than part-time employment, also submit an income certificate.
		Unemployed	Income certificate
		Self-employed	Income certificate Copy of final income tax return Copy of income statement (profit and loss statement) Note: If the business has been discontinued, submit a notice of business discontinuation. (In such cases, there is no need to submit copies of the final income tax return, income statement, profit and loss statement.)
	Actual (adopted) parents	Documents required in all cases: Survey Form of Livelihood Dependency on Insured Person Certificate of residence (indicating all residents of household, all family members, and relationship between all residents) Official copy of family register (showing relationship between insured person and person to be certified) Copy of most recent pension income certificate (notice of revision to pension amount, pension remittance notice, etc.) if receiving old age pension, disability pension, survivor’s pension, or other pension benefits		Click here.** Also click here if self-employed.
		Retired	Unemployment Benefits Receipt Confirmation Form If waiving unemployment benefits, also submit the Unemployment Benefits Waiver Confirmation Form.
		Retired	One of the following: Copy of pay statement for the most recent six months and retirement certificate or certificate of loss of eligibility for health insurance Employment insurance separation slips no. 1 and no. 2 (copies) Certificate of eligibility for employment insurance benefits (copy)
		Employed part-time	One of the following: Employment contract (copy), etc. Pay statement for the most recent three months (copy) and document indicating details of most recent bonus (copy) Note: If receiving income from a source other than part-time employment, also submit an income certificate.
		Unemployed	Income certificate
		Self-employed	Income certificate Copy of final income tax return Copy of income statement (profit and loss statement) Note: If the business has been discontinued, submit a notice of business discontinuation. (In such cases, there is no need to submit copies of the final income tax return, income statement, profit and loss statement.)
	Mother and father in law	In principle, he or she must live with the insured person (not eligible for dependent certification if living separately). Other requirements and documents are the same as for an actual (adopted) parent.
Living separately		Both of the following in addition to the documents required for those living together: Official copy of family register if the certificate of residence does not show relationship between all family members (In such cases, the certificate of residence is not required.) Proof of remittance of livelihood funds for at least three months (e.g., copy of bank passbook) (The proof of remittance is not required if the insured person lives apart from his or her spouse and children due to unaccompanied posting for company reasons.)

* For dependents who do not have certificates of residence in Japan because they reside overseas, submit documents certifying the family relationship (e.g., an abstract of family register) and the documents shown in the table below.

Reasons for exception		Certifying documentation (Attach Japanese translations.)
(1)	Student studying abroad	Copy of visa, student ID, certificate of school attendance, certificate of school admission
(2)	Family member accompanying an insured person posted abroad	Copy of visa, written appointment overseas, certificate of residence issued by a foreign public agency, etc.
(3)	Person traveling abroad temporarily for sightseeing, recreation, volunteer activities, or other reasons unrelated to employment	Copy of visa, certificate of agency dispatched for volunteer activities, certificate of consent to participate in volunteer activities
(4)	Person recognized as equivalent to (2) above due to family relationship to an insured person arising while the insured person is posted abroad	Copy of documentation certifying birth, marriage, etc.
(5)	In addition to (1)-(4) above, person recognized to have a livelihood based in Japan in consideration of purposes of traveling abroad and other circumstances	Subject to determination on a case-by-case basis. Please contact the Health Insurance Society

(*) A list of eligible persons confirmed by the employer may be submitted in place of the documents to attach.
** See "Certification of dependents" under Q&A.