Japan PLF EN – Mega Forms

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Personal information

Nationality *

Country of residence *

Last name *

Sexe *
MaleFemale

Date of Birth *

Travel information

Date of arrival in Japan *

Airline name *

Passport Number *

Flight number *

Accommodation in Japan

Enter your accommodation address for isolation after arriving in Japan (hotel, home, etc.).

Postal code *

Prefecture *

Municipality *

Town *

Your home address (Chome address) *

Exemple : 1-1, 1-2-3

Please select for your accommodation *
Individual houseMulti-unit complex (condominium, apartment building, etc.)Hotel, lodge etc..

Departure details

If you live outside of Japan, enter information about your plans to leave Japan.

Planned departure date *

By plane

Departure airport name *

Departure flight number *

By boat

Port of departure name

Departure ship name

Travel history

Please select the regions (countries) in which you have stayed in the last 14 days

Country

Eligibility questions

In the last 14 days, have you been in contact with someone who had symptoms such as fever or cough? *
YesNo

In the last 14 days, have you been in contact with an infected patient? *
YesNo

Regarding your current physical condition, is there anything wrong? *
YesNo

FeverCoughFatigueOther

Do you use a fever reducer, cold medicine, pain reliever or other medicine? *
YesNo

Contact information

E-mail *

Phone number *