Medical certificate related (children)
Updated: April 24, 2024
It is in PDF file format, so please print it out and use it.
Note: We recommend plain paper and A4 print size.
Thermal paper for thermal printers cannot be accepted.
Applying for reimbursement of medical expenses paid
We will refund the medical expenses paid to the medical institution (the self-paid portion of insured medical treatment).
Please apply following the instructions at the link.
Note : Applications must be submitted within 5 years from the day after the payment of medical expenses and within the validity period of the medical certificate.
Note : If you have other special medical expenses, you may need additional documents, so please inquire at the Child Care Support Division.
Note : It takes about two months from application to payment (account transfer).
Medical expenses subsidy system for infants, children attending compulsory education, high school students, etc. (Marunyu, Maruko, Maru Ao)
First application in Inagi City (moving in, birth of first child, etc.)
Application form for medical certificate (double-sided printing) (PDF: 469KB)
[Example] Application form for medical certificate (PDF: 554KB)
Second and subsequent applications in Inagi City (birth of second and subsequent children, etc.)
[Example] Application form for medical certificate (PDF: 527KB)
Reissuance of medical certificate (for those who have lost it, etc.)
Application for reissuance of medical certificate (PDF: 75KB)
[Example] Application form for reissuance of medical certificate (PDF: 163KB)
Notification of changes (changes in insurance, name, address, etc.)
Notification of change (extinction) of medical certificate application details (PDF: 124KB)
If a representative applies
Premature infant care medical benefit system
Childcare medical benefit application form (PDF: 134KB)
[Example] Childcare Medical Benefit Application Form (PDF: 199KB)
Childcare medical opinion statement (PDF: 91KB)
Childcare medical household record (PDF: 102KB)
[Example] Childcare and Medical Care Household Report (PDF: 165KB)
Consent form for local tax information inquiries (PDF: 127KB)
Note: The consent form for local tax information inquiries must be submitted only if any of the following apply to you:
- If the application date is between January and June, applicants and cohabitants who were not registered as residents of Inagi City as of January 1 of the previous year
- If the application date is between July and December, the applicant and cohabitants are not registered as residents of Inagi City as of January 1 of the same year.
Note: You may be asked to submit additional documents during the review process of the submitted documents.
If a representative applies
Documents that can be submitted by mail
The above documents can also be submitted by mail.
Please check the attached documents on the website and make sure that there are no omissions in the form, seals, or missing documents before submitting.
Points to note when submitting by mail
The date of receipt by mail is the date the application/notification arrives at City Hall.
If the date of delivery to the city hall is delayed due to a mail accident, etc., the date of eligibility for benefits may be delayed (the month in which you begin receiving benefits or the start of the validity period of your medical certificate may be delayed). In order to ensure that the application form/notification reaches the city hall, please send it by registered mail or simple registered mail.
If there are any deficiencies in your application or notification, we will contact you later by phone or letter. Please be sure to write your address, name, and phone number.
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
Inquiries about this page
Inagi City Child Welfare Department Childcare Support Division
2111 Higashi-Naganuma, Inagi-shi, Tokyo
Phone: 042-378-2111 Fax: 042-377-4781