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How should I write a power of attorney when submitting a notification for National Health Insurance?

Updated: April 27, 2022

Please fill in the details of the procedure, the date of delegation, the name and address of the delegator and the mandator, and affix your seal.
You can also use the proxy appointment form that can be downloaded from the page below.

Note: At the time of notification, it is necessary to verify the identity of the mandated person, so please bring identification documents (driver's license, passport, My Number card, etc.)

Application form download (related to National Health Insurance)

Inquiries about this page

Inagi City Citizens Department Insurance and Pension Division
2111 Higashi Naganuma, Inagi City, Tokyo
Phone: 042-378-2111 Fax: 042-377-4781

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National Health Insurance

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Inagi city official mascot Nashinosuke Inagi
2111 Higashi Naganuma, Inagi City, Tokyo 206-8601
Open agency hours: 8:30 a.m. to 5:00 p.m. Main phone number: 042-378-2111 Fax: 042-377-4781
Copyright (C) Inagi City. All rights reserved.
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