Note: You may need the Japanese fonts for Adobe Acrobat to view these. If you do not have them, try the PDF (with image) version if it is available.  In case you need it, here is a link to download Acrobat Reader 7.

Form Name, Japanese: 不受理申出（ふじゅりもうしで)

Form Name, Roumaji: fujyurimouside

Blank PDF Forms (A3 size): two pages together

Blank PDF Forms (A4 size): page 1,  page 2

Annotated PDF Form (A4 size): page 1, page 2  (described below)

Filled-in Sample: <please send me one and I will post>

Description

This is a generic form, and you must fill it in, in a certain way, to prevent your child's Japanese parent from allowing someone else to adopt your child.  (Im not sure who this can apply to, perhaps only to grandparents?? Also, there may be multiple types of adoption in Japan.  Beware.  If anyone understands the adoption process and the dangers, please send any information you can to webmaster @ crnjapan.com)  Note that this same form can be used for other purposes also, so be sure to fill it in properly for your purpose.

See our section on Adoption for further information.

My "impression", and I cant honestly remember why I have this impression, is that you could submit it over and over. (In the back of my mind I think remember hearing someone once say they had submitted a form like this for preventing a divorce several times, but cant remember for sure.)  So that's just a guess.   But also, seems like the point would be lost if you could not submit multiple times. You probably need some overlap in dates to be really careful.

What Else To Include When Submitting the Form

1. •Copy of the koseki on which your child is registered.  Hopefully your name is on this also.  If not, you had better get to Japan and get yourself on that koseki. I cant imagine how to do that without going to Japan.  (OK, perhaps you can arrange that at a local Japanese embassy or consulate.)
   

2. •Copy of your Foreigner Registration (if you are a Japan resident and have one)
   

3. •Copy of your passport (information page and picture page) for identification
   

4. •Stamped self-addresses return envelope.  See notes on stamped self-addressed envelopes.
   

5. •???Other???
   

Fee

You must submit XXX (Unknown at this time) Japanese yen.  See notes on submitting fees for forms.  This may be free since you are not getting printouts in return.

Where to Submit To

The government office where the koseki is registered.  i.e. in Tokyo, a ku-yakusyo.  In Gunma-ken, a si-yakusyo. etc.

Translation and Annotations

The image downloadable at the top of this page, "Annotated JPG Form," has annotations that correspond to the numbers and letters in the translations below.

Although the proper way to fill this form out for a divorce prevention is pretty clear, some sections are not quite clear yet for the prevention of adoption.  For example, there is no more husband and wife.  So do you check the "Other" category on line 2 and fill in "Father" and "Mother", then use the additional area on the second page for the child or children?

PAGE 1

1. Application Date.  YEAR 年　 MONTH月　 DAY日 (This form seems to want the year in Era [nengo] format.  But if you don't know that, just use the standard Western format year, e.g. 2003.)

2. Name of the city/ward/town/village you are submitting this to.  (Also, if you can write the kanji for SAMA 様, cross out the DONO 殿 and write SAMA  様.  But if you cant, don't worry.  It's just a minor formality.)

3. Type of applications (prevention of the following)

1. A.Divorce [協議離婚届　kyougi rikon todoke]
   

2. B.Marriage [ konnin todoke]
   

3. C.Adoption contract [ youshi engumi todoke]
   

4. D.Disowning of adopted child [youshi rien todoke]
   

5. E.Other [ sono ta]
   

4. (Pronunciation) / Full Name / Date of Birth (year, month, day)  [(yomikata) shimei seinengappi] 

If you are a non-Japanese submitting this form, you should fill in your name as it appears on the identification you send along with this form.  Presumably a copy of your passport.

1. A.Husband [ otto]
   

2. B.Husband (not) to be [ otto to naru hito]
   

3. C.Other [ sono ta]
   

4. D.Wife [ tsuma]
   

5. E.Wife (not) to be [ tsuma to naru hito]
   

6. F.Other [ sono ta]
   

4G. BLANK

If you fill in kanji in the (4C) and (4D) area(s) then put the pronunciation of those kanji here in either hiragana or katakana.  (If you are filling in the name of a Japanese person, you should definitely use the kanji for their name) If you use a roman character name for the name of a non-Japanese, you could optionally put the Japanese pronunciation here. 

4H. Surname (last name)

4I. Given Name (first name)  

If this person has a middle name, you should put it here also, after the given name, with a space in between.

4J.  Year( 年 nen)　 Month (月 tsuki)　 Day (日 hi)

5. Address (as registered on Residency Registration) [jyusho (jyuminntouroku wo site iru tokoro)]  

If putting the address in Japanese, you should probably fill in the pronunciation for the kanji in area 5A.  It is unclear what to do if you cannot find their jyuuminhyou (Residency Registration).   Can we get by with just t he Honseki?  Or could this be used as a good reason for getting someone's jyuuminhyou if you do not know it already?

6. Official Address of Family Register [ hon seki]  

If putting the address in Japanese, you should probably fill in the pronunciation for the kanji in area 6A.  If you are not a Japanese citizen, then just fill in your citizenship, i.e. "American citizen". You should probably be careful that this is the same as what is listed for you on the koseki and in the copy of your passport that you will send along.  On the koseki, it will look something like 国籍アメリカ合衆国YOUR-NAME but with your country's name rather than アメリカ合衆国 which the the USA.  In this case, just leave 6B and 6C blank.

6B. (Enter the address in this space.  Note that a honseki address is usually shorter than a normal address.  For example, the address area in (3) has a GOU （号）symbol at the end, whereas the honseki address does not.)

6C. Full Name of Head of Household. [筆頭者 hittousha no shimei] 

This is the person who is listed at the far right of the koseki.  In an international marriage, it would always be the Japanese citizen.  In a household with one parent, it would be the parent.

7.  Reason for application

1. A.I have no with to file for this type of application and I have never signed or sealed this type of application. [todokede no ishi ga naku, todokesho ni shmei ounin shita koto mo nai.]
   

2. B.I have signed or sealed an application of this type but subsequently changed my mind and no longer with to continue the application proceedings.  [todokesho ni shomei ouin sita ga, sono ato todokede no ishi wo nakushita.]
   

8. Term of application [ fujuri kikan]

1. A.Six months from the date of this application [ hon moushidesho uketuke no hi kara rokkagetsu kan]
   

2. B.From the date of this application until....year...month...day.  (Period must not exceed six months.)  [ hon moushidesho uketsuke no hi kara ...nen ...gatu ...hi made (rokkagetsu wo koenai you ni suru koto)]
   

9. Other [sono ta] (Its unclear what might go in here.  Anything else you need to say I guess.)

10. If the above indicated type of application is made during the effective period of this form, please do not accept it.  [Jouki todokede ga fujuri kanan chuu ni teishutsu sareta baai ni wa, kore wo juri shinai you onegai shimasu.]

11A. Signature and seal of the applicant.  [moushidebito syoumei ???in]

11B. Seal [in] 

Imprint your seal over the 印 symbol on the far right.  If you have no hanko to use as a seal, then you may want to try just initialing it.  You may also want to see our section on Registering an Official Seal.

12A. Contact Address (Preferred method of contact) [renraku saki (renraku houhou no kibou)]

12B. Telephone Number [denwa]

12C. Preference [kibou]  

presumably mail or telephone.  you might also try an email address, but you would not want to make that the only method of contact.　　I tried the following to indicate a first and second choice, just in case they did not like the email option. (1) email: myemail@here.com  (2) postal mail (郵便）