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Passport
Residence card, Special Permanent Resident Cetificate
Date of Birth
Nationality
Qualification certificate
Date of issuance
Issued by
Qualification certificate
original language Date of Issue
Alphabet
Issued by
Qualification certificate
Date of Issue
Qualifying
Authority
Issued by
Yes. No.
Period (1)
Experience in total Certificate (1)
Period
Independent practice
Employee
Issued by Year(s)
Name of Office
Office location
Status at that time
Joint management
(Date of Filing)
Document attached
to certify that the
qualification has
some limitations
Experience
period included
Detailed statement
attached to explain
in the case that the
"work pattern" falls
under "others"
The government or private
enterprise, or others
Month(s)
Date of
issuance
Matters ofexamName of
Applicant
Professional
Experience
Assertions
Final academic
background as a
basis for qualification
Legal
Qualification/
Admission
Date of Issue
Jurisdiction of
Primary
Qualification
(state, province,
etc.)
Date of obtaining
the qualification
Issuing
Authority
As mentioned above
Date of
Issue
Contact Point in Japan for procedural purposes
Nationality
Date of
Birth
(Alphabet)
Name of
Applicant
For application for approval
GraduationdateSpecified foreign law that the
applicant simultaneously
applies for designation
Passport-related
information
For Preliminary Examination
[experience period
certified in the Jurisdiction of Primary
Qualification]
Work pattern
Name of
Faculty
Name of Primary
Qualification
(in the
Jurisdiction of
Primary
Qualification)
Has the applicant
been subject to
disciplinary
punishment?
Certification method and evidentiary material(s)
Name of the law office
the applicant intends to work
For the attention of :
Date of
Expiration
Name of Bar Association,
which you intend to join in Japan
Other qualifications of the
applicant which are not
applied for approval or
designation
(original language)
Notes
Name of
School
Issued by
Number
Verification
statement (a
document to explain
evidence) attached
Document attached
to describe
applicable provisions
of the legislation
that governs their
qualification
Detailed written
statement attached
to explain the
disciplinary
punishment imposed
Written statement on disciplinary punishment
As stated in Attachment
Written statement or materials, if the applicant does
not have a certificate of their qualification
Other certificate(such as a certificate of all matters
registered in the family register)
Personal Statement *to write in English only
Academic
degree/title
earned
period (2)
Experience in total Certificate (2)
Period Date of issuance
Independent practice
Employee Issued by
Name of Office
Office location
Status at that time
period (3)
Experience in total Certificate (3)
Period Date of issuance
Independent practice
Employee
Issued by
Name of Office Certificate (4)
Date of issuance
Office location
Status at that time
Issued by
period (4)
Experience in total
Period
Independent practice
Employee
1 Date of Issue
Name of Office
Issued by
Office location 2 Date of issue
Status at that time Issued by
period (5)
Experience in total Certificate (5)
Period Date of issuance
Providing labor services
year(s)
Issued by and
Name of Office month(s)
Certificate (6)
Office location Date of issuance
(In Japan)
Issued by
Status at that time
period (6)
Experience in total
Period
Providing labor services
Name of Office
Office location
Employer’s name
Status at that time
(in third
jurisdiction(s))[as certified in third county(ies)]
Other Professional Experience is shown in an
attached document. If you need to addition.
Joint management
The government or private enterprise, or others
Joint management
Joint management
Professional
Experience
period included
Work pattern
Other Professional Experience is shown in an
attached document.
Written statement or materials, if the applicant does
not have a certificate of their lawful activities in such
third jurisdiction(s)
(in the
Jurisdiction
of Primary
Qualification)
Professional
Experience
Other Professional Experience is shown in an
attached document.
Work pattern
Aggregated
Total in Japan
Year(s)
Month(s)
Certificate of
Professional
Experience other
than (3) and (4)
Detailed statement
attached to explain
in the case that the
"work pattern" falls
under "others"
Inventory of
Evidence with
documents to
explain evidence
attached
Work pattern
Professional
Experience
The government or private enterprise, or
others
The government or private enterprise, or others
Professional
Experience
Employer’s name
Work pattern
Certificate of
Professional
Experience other
than (1) and (2)
Certificate on qualification, registration, or other
lawful activities in a third nation
Work pattern
 days
Employee
Prepared on
Prepared by
Prepared on
Prepared by
Prepared on
Prepared by
Independent practice
Prepared on
Prepared by
Prepared on
Prepared byJPYPrepared on
Prepared by
(Please circle the applicable one.)
Prepared on
Prepared by
Prepared on
Prepared byJPYPrepared on
Prepared by
Joint management/Foreign law joint enterprise
Estimated annual operating cost for the
office
The applicant’s business plan and financial
basis are stated in the right column.
Document on incorporation (start-up) funds and other
financial basis
Document attached
to explain secure of
the office (a written
contract etc.)
Document on
incorporation (start-
up) funds attached
Document attached
on business plan
Written oath
attached on citing
other accompanying
document(s) for
application for
approval.
Lease agreement or other document on securing the
office.
The applicant’s business plan and financial
basis are stated in the right column.
Location and name of the office
The applicant’s business plan and
financial basis are stated in the right
column.
As stated in the Attachment.
Outline of
Certification
Work pattern
other special matters
Document on other
special matters
attached
Document attached
to explain securing
the office (a written
contract etc.) and
document on
incorporation (start-
up) funds attached
Written agreement or
other document attached
to certify the joint
management’s(or foreign
law joint
enterprise's)conditions,
such as distribution of
revenues and
expenditures (contract,
etc.)
Stay in Japan for
more than 180
days per year
Document attached
to describe the
outline of the office
Certificate attached
on employment
contract, the
employer’s financial
basis, or securing
the office.
The number of days for
scheduled overseas activities
As stated in the Attachment.
As stated in the Attachment.
Location and name of the office
Document on incorporation (start-up) funds and other
financial basis
Estimated annual operating cost for the
office
Future activity plan and other special
matters
Written agreement or other document describing joint management’s(or
foreign law joint enterprise's) contract terms
Lease agreement or other document on securing the
office.
As evidenced
Future activity plan and other special
matters
Document in which they pledge (Sworn Statement)
(at the time of application for approval)
Employment contract or other document clearly
describing employment conditions.
Lease agreement or other document on securing the
office.
Audit report or other document on the employer’s
financial basis.
The applicant does not fall under any disqualification cause
as mentioned in Formats 2, 3, and 4, as attached
The total period
asserted
Scheduled activity
period
Grounds for the
disqualification
the will to
perform
professional
duties faithfully
Activity period
Total Period of
Professional
Experience
Outline of the employer’s office is stated
in an attached document.
Document on business plan
 Others
Prepared on
Prepared by
Prepared on
Prepared by Prepared on
Prepared by
Address
Prepared on
Residence Prepared by
As attached
Prepared on
Guaranteed by
Prepared on
Guaranteed by
Domestic professional liability insurance
Prepared on
Prepared by
Guarantee of domestic office in Japan
Prepared on
Prepared by
Prepared on
Prepared byYesNO
ApplicantDateOther certificates
Location and name of the office
Lease agreement or other document on securing the
residence
Document guaranteeing scheduled securing the
residence
Document on incorporation (start-up) funds and other
financial basis
As stated in the attached document(s)
Other certification method
The office's latest Balance Sheet
Document certifying the office's assets
The applicant has the insurance/guarantee for
compensating for possible damages as follows.
Lawyer's liability insurance by the
applicant personally
Insurance/guarantee of law firm in the home
nation / Foreign headquarter
Document certifying the office's assets
Certificate issued by C.P.A.
Method of securing your residence
Document certifying the ability for compensation for
damages
Document certifying the ability for compensation for
damages
Certificate attached
on employment
contract, the
employer’s financial
basis
Copy of certificate
attached to describe
the insurance
coverage
Document attached
to explain securing
the office (a written
contract etc.) and
document on
incorporation (start-
up) funds attached
Document attached
regarding any other
work patterns
arrangement
Document certifying the ability for compensation for
damages
Employment contract or other document clearly
describing employment conditions.
I hereby provide my personal statement as mentioned above. Evidentiary materials that serve as proof for the descriptions herein are
stated in the corresponding columns and are true and correct.
Is the Jurisdiction of Primary Qualification a WTO
member state?
Lease agreement or
other document on
securing the
residence; attached
Document attached
to guarantee
secureing your
residence
Document attached
to certify any other
relevant matter
Insurance by applicant’s office
other special matters
Document on business plan or other work patterns
regarding arrangement
Name in full
(Print)
Professional
Liability
Compensation
Reciprocity
principle
Certificate issued by C.P.A.
The headquarters' latest balance sheet
Written statement on professional
liability compensation for damages
the ability to
compensate for
damages
Document attached
to certify any other
relevant matter
Document certifying the reciprocity in the case that
the jurisdiction is not a member state of WTO
Work pattern
Establish your own office while working
for the legal affairs section in a company
The applicant works for a certain
company and only engages in legal
affairs for such company.
Other