Last updated: July 20, 2021
Note: We recommend plain paper and A4 print size. Thermal paper for thermal printers cannot be accepted.
Notification of appointment of agent (power of attorney) (PDF: 75KB)
Notification regarding special insured persons, etc. (Excel: 41KB)
Notification regarding specially insured persons, etc. (PDF: 132KB)
Complete set of documents required for third party actions (traffic accident) (Excel: 155KB)
Complete set of documents required for third party actions [sample entry for traffic accidents] (Excel: 140KB)
Required documents for third-party actions (non-traffic accidents 1) (Word: 46KB)
Required documents for third party acts (other than traffic accidents 2) (Word: 37KB)
Inagi City Citizens Department Insurance and Pension Division Phone: 042-378-2111
