Year Month Day

certificate and notice of results.

1 Necessary for admission into university or graduate school in your own country.

2 Necessary for admission into university or graduate school in Japan.

3 Necessary for admission or as proof of proficiency for other educational institution in your

own country.

4 Necessary for admission or as proof of proficiency for other educational institution in Japan.

5 Useful for work or will be useful in order to attain employment, secure salary increase or

promotion in your own country.

6 Useful in order to gain employment or secure a salary increase or promotion in Japan.

7 Necessary for applying for national examinations such as those for doctors and nurses in Japan.

8 Necessary for applying for visa and resident status in Japan.

9 In case you have lost the certificates issued before.

10 other　（specify：　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　）

Date / /

Application for Japanese-Language Proficiency Test Certificate of Result and Scores I hereby request a Japanese-Language Proficiency Test Certificate of Result and Scores, the official test

Name （in Roman alphabet）

Date of birth Year Month Day

Test year

For those who took the test in 2009 or earlier;

Registration number

Test level Level 1 Level 2 Level 3 Level 4 ←Circle one

－

For those who took the test in 2010 and after;

Registration number

Test level N１ N2 N3 N4 N5 ←Circle one

－

Test location Country City

Mailing address（If this address is outside of

Japan, please use Romanalphabet）

Zip/Postal code Country

You must add a letter of proxy if a friend, teacher, or colleague is filling this application for you.

FAX to: The Japan Foundation Center for Japanese-Language Testing

　　　　　From outside Japan： +81-3-5367-1025　　　　　From within Japan　： 03-5367-1025

Telephone number

E-mail address

Remarks

For what will you use thecirtificates of results andscores? Circle the numbersof the right items that applyto you. If multiple itemsapply, circle all applicableitems.

If you do not remember your registration number, please be sure to fill in 【Test year】, 【Test level】, and【Test location】.

Please fax a photocopy of your proof of identification (copy of your passport is preferred) along with this application. Ifthe name on your proof of identification is written in Kanji , be sure to write your name both in Kanji and Romanalphabet in box 【Name】 above.