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受 験 願 書
Application Form
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Payment Number
受験上の配慮を希望 Request for Special Testing Accommodations
No
Yes
受験レベル Test Level
受験地 Test Site
名前 Name (as per NRIC)
NRIC or Passport No.
(Required)
(NRIC last 4 digits – e.g. 123A / Passport last 4 digits )
性別 Gender
男 Male
女 Female
生年月日 Date of Birth (mm/dd/yyyy)
(Required)
MM slash DD slash YYYY
オンライン結果通知用暗証番号(8桁の数字のみ) 8-digit passcode (numbers only) for Online Test Results Announcement
母語 Native Language
(Required)
Refer to language code list in Test guide - Pg 27
住所 (番地）Address (Street and Block number)
(Required)
(please fill in your address - Block Number and street here)
部屋番号など Unit Number (indicate with #__-____)
(Required)
(please fill in your unit number here as # __- _____)
国Country
(Required)
郵便番号 Postal Code
(Required)
電話番号 Telephone No.
(Required)
電子メール E-mail
日本語学習機関名 Institution where you are studying (or studied) Japanese-Language
日本語学習の場(1~6から1つ選ぶ) Place of learning Japanese ( Choose a number from 1 to 6)
1
2
3
4
5
6
受験目的(1~8から1つ選ぶ) Reason for taking this exam(Choose a number from 1 to 8)
1
2
3
4
5
6
7
8
職業(1~6から1つ選ぶ) Occupation (Choose a number from 1 to 6)
1
2
3
4
5
6
職業の種類(1~6から1つ選ぶ) Occupational details (Choose a number from 1 to 6)
1
2
3
4
5
6
日本語との接触媒体 Media via which you come into contact with Japanese language
1
2
3
4
5
6
7
8
9
日本語を使用する相手 The person with whom you usually communicate in Japanese
先生 with a teacher
1 はなす Speaking
2 きく Listening
3 よむ Reading
4 かく Writing
5 あてはまらない None of the above
友人 with friends
1 はなす Speaking
2 きく Listening
3 よむ Reading
4 かく Writing
5 あてはまらない None of the above
家族 with family
1 はなす Speaking
2 きく Listening
3 よむ Reading
4 かく Writing
5 あてはまらない None of the above
上司 with a supervisor
1 はなす Speaking
2 きく Listening
3 よむ Reading
4 かく Writing
5 あてはまらない None of the above
同僚 with colleagues
1 はなす Speaking
2 きく Listening
3 よむ Reading
4 かく Writing
5 あてはまらない None of the above
顧客 with customers
1 はなす Speaking
2 きく Listening
3 よむ Reading
4 かく Writing
5 あてはまらない None of the above
過去受験回数 Times of taking JLPT
N1/旧1級 ex Level 1
Select One
1
2
3
4
5
6
7
8
9
N2/旧2級 ex Level 2
Select One
1
2
3
4
5
6
7
8
9
N3
Select One
1
2
3
4
5
6
7
8
9
N4/旧3級 ex Level 3
Select One
1
2
3
4
5
6
7
8
9
N5/旧4級
Select One
1
2
3
4
5
6
7
8
9
Hidden
N1/旧1級 ex Level 1
Hidden
N2/旧2級 ex Level 2
Hidden
N3
Hidden
N4/旧3級 ex Level 3
Hidden
N5/旧4級
最終の合否 Pass/Fail of the last time at each level
N1/旧1級 ex Level 1
合(Pass)
否(Fail)
N2/旧2級 ex Level 2
合(Pass)
否(Fail)
N3
合(Pass)
否(Fail)
N4/旧3級 ex Level 3
合(Pass)
否(Fail)
N5/旧4級 ex Level 4
合(Pass)
否(Fail)
Consent
(Required)
I agree to the Terms & Conditions.
この受験案内に書いてあるすべてのことを理解し、同意した上で受験を申し込みます。
I, by submitting this form, understand and agree to all the conditions and contents of the Test Guide.
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