Forms and entry examples of various declaration forms

According to Article 61 of the Public Assistance Act, those receiving social security must immediately notify the Life Support Division of the ward receiving welfare when there is a change in their income or asset status. In addition to submission by the next agency, submission by mail etc. is possible.

Last Updated February 1, 2025

Income report (for monthly use), asset report form, entry example

Examples of forms and entry
	Form (Excel)	Form (PDF)	Example of description
Income report (for monthly use)	Income report style (Excel: 186KB)	Income report (PDF: 111KB)	Example of income report entry (PDF: 225KB)
Income report (for monthly use)	※Please submit a copy of documents that show the following amount as attachments. Salary statement, notice showing the amount of pension, allowance, etc., passbook showing the status of remittance, notice of benefits such as life insurance, notice of property income, etc.
Asset declaration	Asset Declaration Form (Excel: 187KB)	Asset Declaration Form (PDF: 137KB)	Example of Asset Declaration Form (PDF: 193KB)
Asset declaration	※Please submit a copy of documents that show the following amount as attachments. Property tax payment letter of advice that shows the ownership of land and buildings, passbooks, securities certificates, certificates that show the status of ownership of life insurance, automobile inspection certificate, liability insurance certificate, voluntary insurance certificate, precious metals, etc. Purchase statement that shows the status of possession of expensive items

Submission address

After filling out the report, please submit it to the Living Support Division of the ward receiving welfare.

Contact information of life support section of each ward

You may need a separate PDF reader to open a PDF file.
If you do not have it, you can download it free of charge from Adobe.
To download Adobe Acrobat Reader DC