Download various forms (for businesses)

Click here for the form for businesses

Application for certification of nursing care/support requirements (PDF format)

Application form for nursing care insurance certification of need for nursing care or assistance (double-sided printing) (PDF: 495KB)

(Example) Application form for certification of long-term care and support required under nursing care insurance (PDF: 684KB)

Application for cancellation of long-term care insurance (certification of needing long-term care/support) (PDF: 76KB)

Questionnaire for preparing the attending physician's opinion (PDF: 275KB)

Application for certification of nursing care/support requirements (Word format)

Long-term care insurance nursing care/support required certification application (double-sided printing) (Word: 34KB)

Long-term care insurance (certification of needing long-term care/support) cancellation application (Word: 20KB)

Questionnaire for preparing the attending physician's opinion (Word: 37KB)

Other forms (PDF format)

Application for reissue of nursing care insurance certificate, etc. (PDF: 296KB)

Application for Nursing Care Insurance Burden Limit Approval (PDF: 157KB)

Special address application/change/termination notification form (PDF: 160KB)

[For individuals] Personal information disclosure request form (PDF: 299KB)

Notification of destination setting for nursing care insurance-related documents (PDF: 97KB)

Power of attorney for nursing care insurance related procedures (PDF: 132KB)

Other formats (Word/Excel format)

Application form for (re)issuance of long-term care insurance insurance card, etc. (Excel: 31KB)

Long-term care insurance burden limit certification application (Excel: 67KB)

Special address application/change/termination notification form (Excel: 35KB)

[For individuals] Personal information disclosure request form (Excel: 18KB)

Notification of destination setting for nursing care insurance-related documents (Excel: 42KB)

Power of attorney regarding nursing care insurance related procedures (Word: 13KB)

To open PDF files, you need Adobe Acrobat Reader DC (formerly Adobe Reader).
If you don't have it, you can download it for free from Adobe.
Download Adobe Acrobat Reader DC