Departments

Visa Reservation Form

Check-up itemsRequired
NameRequired
Surname
Given Name

※Name as in passport

Date of birthRequired
GenderRequired
E-mailRequired
Phone numberRequired

※Please type using half-width characters.

Current address
city
prefecture
Kobe Kaisei Hospital
Card No.

※Only if you have

Preferred date
Date of departure(if determined)
Deadline(if required)
HAP ID (or TRN ID)Required
Passport detailsRequired
No:
Date of issue:
Date of expiry:
Issuing country:
Country of birthRequired
Health case IDRequired
VISA categoryRequired
Passport detailsRequired
No:
Date of issue:
Date of expiry:
Issuing country:
Country of birthRequired
VISA categoryRequired
  • Temporary
  • Rsidence
  • Work to Residence
The length of stayRequired
Remarks
Please list any medical history that required treatment or hospitalization, or any current undergoing treatment.