<when you want mail application, please contact Asahi Ward government office Insurance and Pension Division payment responsible beforehand>
１．Limit application, standard burden reduction authorization application
①Limit application, standard burden reduction authorization application (written consent) (PDF: 181KB)
[note] About people 70 years or older, limit application certificate becomes necessary only for income earner (less than taxable income 6.9 million yen) at the same level as active play and person of residence tax tax exemption household. As by showing health insurance card to medical institution, it is window burden to self-pay limit depending on burden ratio about other people 70 years or older, limit application certificate is unnecessary.
About application of limit application certificate
Please confirm this about the details such as burden division. In addition, please note that it limits to the person or family of the household to be able to answer on the telephone about burden division.
２．Medical expenses supply application
①Medical expenses supply application (PDF: 148KB)
Payment of medical expenses
Other styles include statements which contents of medical treatment understand in link.
３．High medical costs dossier
It is documents in conjunction with application of high medical costs. We mail supply application of high medical costs toward the pertinence.
①High medical costs transfer previous engagement seat change monkey appearance book (PDF: 81KB)
②High medical costs application method change monkey appearance book (PDF: 76KB)
③High medical costs automatic transfer return monkey appearance book (PDF: 78KB)
Major medical care expenses supply system
４．Large amount of care adding up medical expenses
Payment of application and self-burden certificate grant applications (PDF: 140KB) such as large amount of care adding up medical expenses
5. Standard burden balance supply application
①Standard burden balance supply application (PDF: 131KB)
①Funeral costs supply application (PDF: 121KB)
②Petition for funeral costs supply application (PDF: 121KB)
Payment of funeral costs
7. Childbirth childcare lump sum supply application
①Childbirth childcare lump sum supply application (PDF: 119KB)
Payment of childbirth childcare lump sum
８．Petition for heir (payment costs are common)
①Petition (PDF: 81KB) about application about payment costs and the receipt
Adobe Acrobat Reader DC (old Adobe Reader) is necessary to open file of Portable Document Format.
Person who does not have can download free of charge from Adobe company.
To downloading of Adobe Acrobat Reader DC