新型コロナウイルスワクチン接種証明書(ワクチンパスポート)の申請
Application for Vaccination Certificate of COVID-19

※2021年7月26日から申請を受付けます。
Applications will be accepted from July 26, 2021.

対象者 Target person

海外渡航の予定があり、入国時に防疫措置の緩和を必要とする人
Those who are planning to travel abroad and need relaxation of epidemic prevention measures at the time of entry.

入国時等において接種証明書が利用可能な国(2021年7月30日時点)
Countries where vaccination certificates can be used at the time of entry (as of July 30, 2021)

イタリア、オーストリア、トルコ、ブルガリア、ポーランド
Italy , Austria , Turkey , Bulgaria , Poland

セントクリストファー・ネービス、セントビンセント、タイ(プーケット島,サムイ島,パンガン島,タオ島のみ)、ドイツ、ホンジュラス、香港、リトアニア
Saint Kitts and Nevis, Saint Vincent, Thailand (Phuket, Koh Samui, Koh Phangan, Koh Tao only), Germany, Honduras, Hong Kong, Lithuania

※韓国については、隔離免除書発行に必要な書類のうちのひとつである「予防接種証明書」として認められます。
For South Korea, it is recognized as a "vaccination certificate", which is one of the documents required to issue a quarantine exemption certificate.

留意事項

下記、外務省ホームページはインターネットエクスプローラーに対応していません。
The following Ministry of Foreign Affairs website does not support Internet Explorer.

For the exemptions and mitigation measures that are actually applied, please refer to the Ministry of Foreign Affairs Overseas Safety Homepage [List of countries / regions where Application for Vaccination Certificate of COVID-19 for overseas travel can be used]. Countries / regions other than the above are currently being confirmed, and will be announced on the Ministry of Foreign Affairs website as soon as they are confirmed.

Please refer to the Overseas Safety Information website [Immigration restrictions for travelers from Japan and Japanese people in each country / region, and conditions / behavior restrictions for entry]of the Ministry of Foreign Affairs for the current immigration restrictions and the conditions and behavioral restrictions for entry in each country around the world. Even if the presentation of a certificate mitigates some epidemic prevention measures, other restrictions may continue to apply.

申請方法 How to apply

志木市新型コロナウイルス感染症ワクチン接種室への来所または郵送で、申請書と添付書類を提出。
Submit the application form and attached documents by visiting or mailing to Shiki City COVID-19 Vaccination Support Office. 

※1度の申請につき、原則1部発行します。
In principle, one copy will be issued for each application.

申請書 Application form

新型コロナワウイルスワクチン接種証明書交付申請書(日本語/英語).pdf [364KB pdfファイル] 

添付書類 Attached document

A:旅券(写しでも可) Passport(Can be copied)
B:新型コロナウイルスワクチン接種券(予防接種済証) または接種記録書(写しでも可) Vaccination Ticket for COVID-19(Certificate of Vaccination for COVID-19),or Vaccination record(Can be copied)
C:返信用封筒(返送先の住所を記載し、84円切手を貼り付けたもの)Reply envelop(The return address is stated and an 84 yen stamp is attached.)

※旅券の記載事項に変更がない再発行申請のときBは省略可能
B can be omitted when applying for reissue without any change in the information on the passport.

場合によって必要な書類 Documents required in some cases

D:旅券に旧姓・別姓・別名(英字)の記載がある場合は、旧姓・別姓・別名(英字)が確認できる「本人確認書類」
例:マイナンバーカード、運転免許証、戸籍、住民票の写し、当該別名・別姓の記載のある外国の旅券

If your passport has a maiden name, another surname, or another name (alphabet), you can check your maiden name, another surname, or another name (alphabet). 
Example: My number card, driver's license, family register, copy of resident's card, foreign passport with the alias and surname

E:代理人による請求の場合は、本人の自署による委任状 [244KB pdfファイル] または法定代理人の資格を証する書類
In the case of a request by an agent, a self-signed "power of attorney [244KB pdfファイル] " or a document certifying the qualification of a legal agent.

F:郵送による申請の場合は、住所の記載された「本人確認書類」
In the case of application by mail, "identification document" with the address.