|
渡航国
Health case country
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NEW ZEALAND |
|
健診受診日
Exam date
*
|
Y
M
D
|
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予約時間
Reserved time
*
|
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名前（ローマ字）
Name
*
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Name as in passport
|
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性別
Gender
*
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生年月日
DOB
*
|
Y
M
D |
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年齢
Age
*
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保護者名（ローマ字）
Name of parent/guardian
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Name of an accompaning person.
Mandatory field for minors under the age 18.
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保護者の続柄
Relationship to the client
|
Mandatory field for minors under the age 18.
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出生国
Country of birth
*
|
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住所
Address
*
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Postal Code
-
Find zip code
|
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日中の連絡先電話番号
Contact telephone number
*
|
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e-mail アドレス
e-mail address
*
|
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健診用個人ID
Health case ID type(If issued)
|
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ID
ID
|
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パスポート情報
Passport details
*
|
Passport No.
Issuing country
Date of issue
Y
M
D
Date of expiry
Y
M
D
|
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ビザの種類
Visa category & type
*
|
|
|
必要な検査項目
Required certificates
*
|
| Type of Medical Certificate |
Fee (excluding tax) |
Object person |
Time Required |
|
|
¥13,000 |
11yrs and above |
30min -1hr |
|
|
¥34,000 |
15yrs and above |
2hrs - 3 hrs |
| ¥30,000 |
11yrs - 14yrs |
1hr - 2hrs |
|
|
¥26,000 |
15yrs and above |
2hrs - 3hrs |
| ¥22,000 |
5yrs - 14yrs |
30min -1hr |
| ¥21,000 |
Under 5yrs |
|
|
¥29,000 |
15yrs and above |
2hrs - 3hrs |
| ¥18,000 |
11yrs - 14yrs |
1hr-2hrs |
|
|
¥21,000 |
15yrs and above |
2hrs - 3hrs |
| ¥10,000 |
Under 15yrs |
30min - 1hr |
|
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渡航国での滞在期間は？
How long do you intend to stay in the health case country?
*
|
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渡航国での職業は
何ですか？
What is your intended occupation in the health case country?
|
*Mandatory field for those applying for a work/skill visa
|
