Application for issuance of vaccination ticket (including application for reissue)

Apply for issuance of vaccination tickets (including reissue applications) by electronic application or mail application .
Application may not be required . For details, please check the link below.
(explanatory note) Application by agent is possible, too.
(Note) Those who do not have a “copy of vaccination history (certificate of vaccination, etc.)” can apply even if they have lost it. may be required.
(annotation) Click here for vaccination certificate (vaccine passport) .

Electronic application

You can apply for one person with one application.
The destination of the vaccination ticket will be the location of the certificate of residence of the person to be vaccinated.
Please use the "application form" below and attach a document that shows your vaccination history (such as a certificate of vaccination) with photo data, etc., and apply.
(explanatory note) When sending is hoped for outside resident's card address , please use mail application as there are necessary documents separately.
Please note that we cannot accept your application if any of your name, address, or date of birth is entered incorrectly.
We do not respond to inquiries regarding application acceptance.

application formLink to external site: Opens in a new window.

(Note) Applications will not be accepted from 10:00 pm on Wednesday, January 25, 5th year of Reiwa to 5:00 am on Thursday, January 26th, 2023 due to scheduled maintenance.

Mail application

You can apply for multiple people in the same household with one application.
Required documents vary depending on the destination of the vaccination ticket.

If the destination of the vaccination ticket is the residence record location

  • Vaccination ticket issuance application form
  • A copy of your vaccination history (certificate of vaccination, etc.)

Please send

If the delivery address of the vaccination ticket is different from the address on the resident card

The required documents differ depending on the applicant.

Application by the person to be vaccinated

  • Vaccination ticket issuance application form
  • A copy of the identity verification document of the person to be vaccinated (license, insurance card, etc.)
  • A copy of the document that can confirm the whereabouts of the vaccinated person (contract for admission to a facility, hospitalization certificate, etc.)
  • A copy of your vaccination history (certificate of vaccination, etc.)

Please send

Application by proxy

  • Vaccination ticket issuance application form
  • Power of attorney (The name of the person entrusted must be signed by the person who entrusted (the person who is vaccinated))
  • A copy of the agent's identity verification document (driver's license, insurance card, etc.)
  • A copy of the document that can confirm the whereabouts of the vaccinated person (contract for admission to a facility, hospitalization certificate, etc.)
  • A copy of your vaccination history (certificate of vaccination, etc.)

Please send

Address to send the application form, application form, etc.

Address to send the application form

〒176-8501 6-12-1 Toyotama Kita, Nerima-ku, Tokyo Nerima Ward Office Residents' Vaccination Section

(explanatory note) We cannot keep application in ward resident office, welfare office.

Application form etc.

Time from application to delivery

1st and 2nd inoculation ticket

After receiving the application, it will be sent in about two weeks.

Vaccination ticket for the third time

After receiving the application, it will be sent approximately one week before five months have passed since the date of the second vaccination. If 5 months have already passed, it will be sent in about 2 weeks.

4th vaccination ticket

After receiving the application, we will send it about two weeks before the 5th month from the date of the third vaccination. If 5 months have already passed, it will be sent in about 2 weeks.

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inquiry

Nerima Ward New Coronavirus Vaccination Call Center Phone: 0120-427-417 Fax: 03-3993-6553

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