Application forms
--How to use--
You can download the application form or the sample when you click the icon from the side to the name of the document you require. Please print the form and it.
indicates the application form or the example respectively.
indicates that the sample is combined with the application form. You can print them out at the same time.
The application form in red is a "read-only" form. Please contact the Sony Health Insurance Society in case you require the document.


All documents are in PDF format. Adobe's Acrobat Reader software is required to view or print them. If Acrobat Reader is not already installed on your computer, please download and install the latest version now.


Documents related to the health insurance card
Dependent Notice (Notice of Change)
Survey form determining eligibility for dependent status
Notice of name change (Change Notices/Corrections)
Notice of Loss and Application for Reissue of Health Insurance Card
Notice of Loss and Application for Reissue of Insurance Benefits Card for the Elderly

Documents required when you leave the company
Voluntary Continuation System Voluntary Continuation Health Insurance System
Special-Case Retired Individuals Medical Care System Application to Join the Special-Case Retired Individuals Medical Care System
Letter of Confirmation
Remittance application (for Sumitomo Mitsui Banking Corp.)    
Automatic remittance application (for postal savings accounts)

Documents related to issuance of certificate
Certificate Issue Request
Certificate Issue Request
(For persons who have lost eligibility, heirs, or representatives)

Documents related to the long-term care insurance
Notice of Exemption/Non-Exemption for long-term care Insurance

Documents related to no. 3 insured persons under the National Pension
Notice on no. 3 insured persons under the National Pension
Change of address notice for no. 3 insured persons under the National Pension
Application for registration under the period for exceptional measures for no. 3 insured persons under the National Pension


Documents related to insurance benefits
Childbirth and Childcare Lump-sum Grant/ Childbirth and childcare additional sum
Childbirth and childcare lump-sum grants/childbirth and childcare lump-sum additional grants (applied for in advance)

Note: For payment directly to the medical care facility on the patient痴 behalf
Childbirth allowance/ Childbirth
allowance additional sum
Injury and Sickness Allowance/ Injury and Sickness Allowance
additional sum
Medical Cost Payment Request
Funeral Expenses (Costs)/ Funeral Expenses (Costs) additional sum
Application for Suspension/ Resumptionof Insurance Benefits Payments
Application for Approval of Transportation Expenses/ Application for Transportation Expenses    
Application for Overseas Medical Care Expenses    
Application [for Resumption] of Insurance Benefits Payments
Application for Health Insurance Maximum Copayment Amount Eligibility Certificate