Date: To: (Ambassador/Consul General) of (country) Applicant: Full name: Nationality: Address (home country): Date of birth: Age: Sex (male/female): I hereby declare that if the above-mentioned applicant enters Japan for the purpose of_____________________________________________________
I shall guarantee the following items: (1) I shall provide the necessary supervision to ensure that the applicant does not engage in activities other than those permitted for the purpose of entry into Japan and abides by Japanese laws and regulations. (2) I shall shoulder the cost of the applicants living expenses and return travel expenses if the applicant is unable to pay them. (3) I shall serve as the applicants guarantor if the applicant in any way becomes involved in Japanese legal proceedings.
(Guarantors signature) Guarantor: Full name: Nationality: Home address: Telephone #: Date of birth: Age: Sex (male/female): Occupation/Employer: Work address: Telephone #: Relationship to applicant:
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