Long-term care insurance related
Updated: October 1, 2024
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Download various forms (for businesses)
Click here for the form for businesses
Long-term care/support certification application (PDF format)
Questionnaire (PDF: 275KB) for chief physician written statement of opinion making
Application for long-term care/support certification (word format)
Questionnaire (Word: 37KB) for chief physician written statement of opinion making
Other forms (PDF format)
Application for reissue of nursing care insurance certificate, etc. (PDF: 296KB)
Long-term care insurance burden limit authorization application (PDF: 157KB)
Address ground exception application, change, end 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)
Proxy (PDF: 132KB) about care insurance-related procedure
Other forms (Word/Excel format)
Identification of long-term care insurance person insured (re) grant application (Excel: 31KB)
Long-term care insurance burden limit authorization application (Excel: 67KB)
Address ground exception application, change, end 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 (Word: 13KB) about care insurance-related procedure
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Inquiries about this page
Elderly Welfare Division, Welfare Department, Inagi City
2111 Higashi Naganuma, Inagi City, Tokyo
Phone: 042-378-2111 Fax: 042-377-4781