Documents to submit when applying for dependent certification

Applying to name a child as a dependent (e.g., certification after leaving employment)

To apply, provide the information specified on the following document and attach the specified certifying documents. Enclose a self-addressed return envelope if you are a Takeda Pharmaceutical Company Limited employee or a Voluntarily and Continuously Insured Person and submit to the Health Insurance Society. If you are not a Takeda Company Limited employee, submit to the section at your company responsible for health insurance administration.
Note that you may be asked to submit documentation in addition to the documents indicated below.

Application form (click here for printable form)

Certifying documents to attach

Documents required in all cases	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 Note: If living separately, proof of remittance of livelihood funds (bank remittance details or certification of remittance such as registered mail for at least three months) is required. (Proof of remittance is not required if the insured person is on an unaccompanied posting for company reasons.)

Documents required in all cases

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

Note: If living separately, proof of remittance of livelihood funds (bank remittance details or certification of remittance such as registered mail for at least three months) is required. (Proof of remittance is not required if the insured person is on an unaccompanied posting for company reasons.)

When leaving employment	1. Unemployment Benefits Receipt Confirmation Form
	2. Choose from cases (1) - (4) for receipt of unemployment benefits.	(1) Planning to receive unemployment benefits Submit the documents under either ① or ② below to confirm the date of leaving employment and amount of unemployment benefits to be received.
		① The documents under either A or B below, whichever can be submitted earlier Copy of pay statement for the most recent six months and retirement certificate Copy of pay statement for the most recent six months and certificate of loss of eligibility for health insurance ** These documents may be obtained promptly after leaving employment by contacting the previous employer and health insurance society ahead of time. ② Copies of employment insurance separation slips no. 1 and no. 2 issued by the previous employer (It takes roughly 10-20 days after leaving employment for these to be sent from the previous employer.) Notes: A family member cannot have dependent status while receiving unemployment benefits at a base allowance daily amount of 3,612 yen/day or more. See "While a dependent receives unemployment benefits under employment insurance (for those leaving their employer on or after April 2, 2016)."
		(2) Planning to waive receipt of unemployment benefits Also submit the Unemployment Benefits Waiver Confirmation Form.
		(3) Already receiving unemployment benefits Submit a copy of the certificate of eligibility for employment insurance benefits.
		(4) If the previous employer did not offer employment insurance Submit either of the following: ① Copy of pay statement or other document showing the previous employer did not offer employment insurance ② If a public employee, certification of end of employment, such as notice of dismissal, since public employees are not eligible for unemployment benefits

Part-time employment	Submit either of the following: Copy of employment contract issued by the employer indicating working conditions, including hours and days worked, hourly wage, etc., or similar documentation of income Copies of pay statement (for at least the most recent three months) and document indicating details of the most recent bonus Note: If receiving income from a source other than part-time employment, also submit an income certificate issued by the municipal government.
Unemployed	Income certificate issued by the municipal government
Self-employed (including agriculture worker)	Income certificate issued by the municipal government Copy of 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 income tax return, income statement, etc.) See "Handling of self-employed family members."

Part-time employment

Submit either of the following:

Copy of employment contract issued by the employer indicating working conditions, including hours and days worked, hourly wage, etc., or similar documentation of income
Copies of pay statement (for at least the most recent three months) and document indicating details of the most recent bonus

Note: If receiving income from a source other than part-time employment, also submit an income certificate issued by the municipal government.

Unemployed

Income certificate issued by the municipal government

Self-employed
(including agriculture worker)

Income certificate issued by the municipal government
Copy of 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 income tax return, income statement, etc.)
See "Handling of self-employed family members."

Note: Submit the above documents within five working days of the date on which the reason for dependency arose (including that date). If the Health Insurance Society receives the documents within five days and certifies dependency, certification will be retroactive to the date on which the reason for dependency arose. If the documents are received more than five working days later, the date of certification will be the date on which the Health Insurance Society received the documents and certified dependency.