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Medical care for the latter-stage elderly

Updated: September 10, 2021

It is in PDF file format, so please print it out and use it.
Note: For documents 2, 3, and 14 below, if someone other than the applicant himself/herself brings them to the counter, please bring something that can verify the identity of the person who brings the application form.

File Download Opens in a new window.1 Acquisition (Change/Loss) Notification of Latter-Stage Elderly Medical Care Insurance (PDF: 86KB)

File Download Opens in a new window.2 Latter-stage elderly medical funeral expenses supply application and petition (PDF: 73KB)

File Download Opens in a new window.Heir representative designation report (PDF: 77KB) about 3 elderly aged 75 or over medical care

File Download Opens in a new window.Confirmation (PDF: 340KB) about notification of 4 heir representative designation

File Download Opens in a new window.5 late-stage elderly medical care reissue application (PDF: 96KB)

File Download Opens in a new window.6 Latter-stage Elderly Medical Care Limit Application/Standard Contribution Reduction Certificate Application Form and Notification of Number of Days of Hospitalization (PDF: 104KB)

File Download Opens in a new window.7 Latter-stage elderly medical care limit application certificate grant application (PDF: 62KB)

File Download Opens in a new window.8 Latter-stage elderly medical insurance premium reduction of taxes application (PDF: 75KB)

File Download Opens in a new window.9 Latter-stage elderly medical care specific disease authorization application (PDF: 79KB)

File Download Opens in a new window.10 Written opinion of a doctor (dentist) for certification of specific diseases for medical care for the elderly (PDF: 94KB)

File Download Opens in a new window.11 Latter-stage elderly medical insurance premium special collection cancellation proposal book (PDF: 85KB)

File Download Opens in a new window.12 Latter-stage elderly medical insurance premium special collection resumption proposal book (PDF: 79KB)

File Download Opens in a new window.13 Latter-stage elderly medical burden division certificate grant application (PDF: 73KB)

File Download Opens in a new window.Destination change request book (PDF: 79KB) of sending thing about 14 elderly aged 75 or over medical care

Note: Plain paper is recommended for print paper, and A4 is recommended for print size.
Thermal paper for thermal printers cannot be accepted.

Adobe Acrobat Reader DC (formerly Adobe Reader) is required to open PDF format files.
If you don't have it, you can download it for free from Adobe.
Get Adobe Acrobat Reader DCDownload Adobe Acrobat Reader DC

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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Insurance and Pension Division

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Inagi city official mascot Nashinosuke Inagi

Inagi City Hall

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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