Date:___________                       

Outline of intended activities

Name of visa applicant                                                          Sex                             Age

   _______________________________________                  ____________            _____________
        (Surname)               (Given and Middle name)


period
In which city or prefecture
do you intend to stay?
Please give an outline of activities you wish to engage in Japan (e.g. travel, work, study)
from
(date)

to
(date)

   
from
(date)

to
(date)

   
from
(date)

to
(date)

   
from
(date)

to
(date)

   
from
(date)

to
(date)

   
from
(date)

to
(date)

   
from
(date)

to
(date)