Application for the booster shot (3rd and 4th dose) vaccination voucher

1

Input your information
2

Confirmation of your information
3

Completion of the application for reissue

About the Application for the booster shot (3rd and 4th dose) vaccination voucher

【The 3rd dose】
If you do not receive the voucher for the booster shot (3rd dose) even when it is time to issue the voucher announced by your municipality, please apply to re-issue the voucher.
Please be aware that it is especially necessary to apply for the voucher in the case of following:
・if you moved to another city after receiving the 2nd dose
・if you received your vaccination oversea (only for those who have completed 2 doses of Pfizer(including Pfizer for 5 to 11 years old.) , Moderna, AstraZeneca or Novavax)
・if you received 2 doses of vaccination through the oversea Japanese vaccination service.

【The 4th dose】
If you are the target of the 4th dose but do not receive the voucher for the booster shot (4th dose) even when it is time to issue the voucher announced by your municipality, please apply to re-issue the voucher.
Please be aware that it is especially necessary to apply for the voucher in the case of following:
・if you moved to another city after receiving the 3rd dose
・if you received your vaccination oversea (only for those who have completed 3 doses of Pfizer(only for people aged 12 years and older.) , Moderna, or Novavax)
・if you received 3 doses of vaccination through the oversea Japanese vaccination service.

Some municipalits do not accept your notifications from this page.

How to apply when your city does not accept the application for the voucher from this website.
Please inquiry at the city for the information about the application at the reception of the city, or application by post.

The target of the booster shot (3rd and 4th dose)

【The 3rd dose】
The 3rd dose is for people over 5 years old who have completed the 2nd dose.

【The 4th dose】
The 4th dose is for the following people who have completed the 3rd inoculation:
・If you are aged 60 years and older
・If you are aged 18 to 59 and have underlying illness
　Others who are recognized by doctors as having a high risk of aggravation.
・If you are aged 18 to 59 and medical personnel, etc.
・If you are aged 18 to 59 and employees of senior citizen facilities, etc.

Application for the booster shot (3rd and 4th dose) vaccination voucher

Fill out the form below, and click the "Confirm" button to proceed to the confirm page.

Municipality on the certification of residence

Select the prefecture.

Select a city.

The selected municipality is not currently accepting vaccination coupon reissue applications on the COVID-19 Vaccine Navi. For more information, please contact the municipality.

Confirmation

If you received a voucher for the booster shot (3rd or 4th dose) from your previous address, please discard it.

Name

First name

Last name

Please enter the last name.

Please enter the last name within 20 characters.

The last name contains invalid characters. Please enter with hiragana, katakana, kanji, and alphanumeric characters, including punctuation and spaces.

Please enter the first name.

Please enter the first name within 20 characters.

The first name contains invalid characters. Please enter with hiragana, katakana, kanji, and alphanumeric characters, including punctuation and spaces.

Date of birth

Please select the year of the date of birth.

Please select the month of the date of birth.

Please select the day of the date of birth.

Please check the date of birth. The selected date does not exist.

Phone number

Please enter the phone number.

Please enter a correct phone number. Please enter 10 digits or 11 digits number beginning with 0.

Please enter the phone number within 11 characters.

The address on the certification of residence

Zip code

Please enter the zip code.

Please enter the zip code with half-width numbers.

Please enter the zip code with 7 charcaters.

Cannot search an address from the zip code.

The address on the certification of residence

Please enter the address.

Please enter the address within 120 characters.

The address contains invalid characters. Please enter with katakana and alphanumeric characters, including punctuation and spaces.

Shipping address
(Only when required)

Shipping address (Only when required)

* Please enter if the shipping address differents from that of your certification of residence.

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Zip code

Please enter the zip code.

Please enter the zip code with half-width numbers.

Please enter the zip code with 7 charcaters.

Cannot search an address from the zip code.

Shipping address

Please enter the address.

Please enter the address within 120 characters.

The address contains invalid characters. Please enter with katakana and alphanumeric characters, including punctuation and spaces.

Name of mansion

Please enter the name of mansion within 40 characters.

The name of mansion contains invalid characters. Please enter with hiragana, katakana, kanji, and alphanumeric characters, including punctuation and spaces.

The number of vaccination

The 3rd dose of vaccination

The 4th dose of vaccination

Please select the number of the booster shot vaccination.

Reason for notification

* If you choose "Others", please enter the reason below.

Please select the reason for notification

You cannot select the reason for notification "18-59 years old" and the reason for being eligible for the 4th dose "Aged 60 years and older" at the same time.

Please input the reason for notification if you choose "others".

Please enter the reason for notification within 120 characters.

The reason for notification contains invalid characters. Please enter with hiragana, katakana, kanji, and alphanumeric characters, including punctuation and spaces.

Status of the 1st and 2nd dose of vaccination

The 1st dose of vaccination

Date of vaccination

* If the date of vaccination is unclear, please fill in with an approximate date.

Please select the year for the date of the 1st vaccination.

Please select the month of the 1st vaccination.

Please select the date of the 1st vaccination.

Please check the date of the 1st vaccination. The selected date does not exist.

Type of vaccination

* Please input the vaccine name if you chose "others".

Please select the type of vaccine for the 1st dose of vaccination.

Please input the vaccine name if you choose "others" for the 1st dose of vaccination.

The name of vaccine for the 1st dose of vaccination contains invalid characters. Please enter with hiragana, katakana, kanji, and alphanumeric characters, including punctuation and spaces.

Please enter the name of vaccine for the 1st dose of vaccination within 120 characters.

Method of vaccination

the city who sent the voucher for vaccination

* If you received your vaccination at a mass vaccination site managed by Self-Defense Force, the province, or the city, please select "vaccination at a vaccination site managed by the city, medical facilities, nursing homes, vaccination site at workplace etc.

Please select the method of the 1st dose of vaccination.

Please select the prefecture that sent the voucher for vaccination.

Please select the city that sent the voucher for vaccination.

Please input the method of vaccination if you chose "others" for the 1st dose of vaccination.

The method of the 1st dose of vaccination contains invalid characters. Please enter with hiragana, katakana, kanji, and alphanumeric characters, including punctuation and spaces.

Please enter the method of vaccination for the 1st dose of vaccination within 120 characters.

The 2nd dose of vaccination

Date of vaccination

* If the date of vaccination is unclear, please fill in with an approximate date.

Please select the year for the date of the 2nd vaccination.

Please select the month of the 2nd vaccination.

Please select the date of the 2nd vaccination.

Please check the date of the 2nd vaccination. The selected date does not exist.

Type of vaccination

Same as the 1st dose of vaccination

* Please input the vaccine name if you chose "others".

Please select the type of vaccine for the 2nd dose of vaccination.

Please input the vaccine name if you choose "others" for the 2nd dose of vaccination.

The name of vaccine for the 2nd dose of vaccination contains invalid characters. Please enter with hiragana, katakana, kanji, and alphanumeric characters, including punctuation and spaces.

Please enter the name of vaccine for the 2nd dose of vaccination within 120 characters.

Method of vaccination

Same as the 1st dose of vaccination

the city who sent the voucher for vaccination

Please select the method of vaccination.

Please select the prefecture that sent the voucher for vaccination.

Please select the city that sent the voucher for vaccination.

Please input the method of vaccination if you chose "others" for the 2nd dose of vaccination.

The method of the 2nd dose of vaccination contains invalid characters. Please enter with hiragana, katakana, kanji, and alphanumeric characters, including punctuation and spaces.

Please enter the method of vaccination for the 2nd dose of vaccination within 120 characters.

The 3rd dose of vaccination

Date of vaccination

* If the date of vaccination is unclear, please fill in with an approximate date.

Please select the year for the date of the 3rd vaccination.

Please select the month of the 3rd vaccination.

Please select the date of the 3rd vaccination.

Please check the date of the 3rd vaccination. The selected date does not exist.

Method of vaccination

the city who sent the voucher for vaccination

Please select the method of vaccination.

Please select the prefecture that sent the voucher for vaccination.

Please select the city that sent the voucher for vaccination.

Please input the method of vaccination if you chose "others" for the 3rd dose of vaccination.

The method of the 3rd dose of vaccination contains invalid characters. Please enter with hiragana, katakana, kanji, and alphanumeric characters, including punctuation and spaces.

Please enter the method of vaccination for the 3rd dose of vaccination within 120 characters.

I agree with the terms of use and privacy policy

You must agree to the terms of use and privacy policy.

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Application for reissue completed

1

Input your information
2

Confirmation of your information
3

Completion of the application for reissue

Application for reissue has been completed

Please keep this receipt number as it will be necessary for inquiries.
In addition, it will take a certain period of time to issue. Please connect with the municipalities directly if it is urgent.

Apply number:

Apply date:

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Application for the booster shot (3rd and 4th dose) vaccination voucher

About the Application for the booster shot (3rd and 4th dose) vaccination voucher

Some municipalits do not accept your notifications from this page.

The target of the booster shot (3rd and 4th dose)

Application for the booster shot (3rd and 4th dose) vaccination voucher

The address on the certification of residence

Shipping address
(Only when required)

Shipping address (Only when required)

Status of the 1st and 2nd dose of vaccination

Status of the 3rd dose of vaccination

Confirmation of your information

Input information

Application for reissue completed

Application for reissue has been completed