After filling out and stamping the application form, eligible persons

１ What are Temporary Welfare Benefits?
Temporary welfare benefits will be paid as a temporary measure, in order to reduce the burden
for persons with low income caused by the increase in sales tax to 8% from April 2014.
２ Who is Eligible
Persons registered as a resident of Shizuoka City on Jan. 1, 2014 (reference date)
who are not taxed Fiscal Year 2014’s resident tax are eligible.
However, dependents of persons who are taxed resident tax, persons who
are wards of a public assistance program etc. are not eligible.
３ Amount of Payment
○Persons who are eligible will receive ¥10,000 each (limited to one-time only)
○Eligible persons for whom any of the following also applies receive additional ¥5,000:
・Recipient of Old Age Basic Pension, Disability Basic Pension, Basic Pension for Survivors etc.
（Persons with right to receive pension for March of FY2014 who will pay April or May’s portion are eligible.)
・Recipient of Child-Rearing Allowance, Special Disability Allowance etc.
（Persons who received allowance etc. for January of FY2014 are eligible.)
４ Application Process
Applications should be submitted to the municipality you were registered in as of the reference date.
Shizuoka City’s application and payment process is as follows:
After filling out and stamping the application form, eligible persons must also attach:
○Copies of the applicant/claimant’s bankbook and ATM card.
（Should include names of financial institution/branch and account type, number and holder’s name)
○Copy of applicant’s identification documents
（Basic Residence Registration card with photo, driver’s license, passport, health insurance card etc.)
After affixing copies, send them in the return envelope provided with the application form.
①
②
Fill out, stamp
application form
Affix copies of applicant
/claimant’s bankbook etc. and
applicant’s ID documents to back
of application form
③ Send/submit
application form
to Shizuoka City
④ Payment
screening by
Shizuoka City
⑤
Benefits are paid
(Result of payment
screening)
(takes 2-3 months)
５ Application Period
Between Tues. Jul. 1, 2014 and Mon. Dec. 15, 2014 (postmark deadline)
Reception windows will be set up at every ward office during this period.
To submit an application at a ward office reception window, please bring your application form,
personal seal and all necessary documentation.
Reception windows are open from 8:30am to 5:15pm (exc. Sat, Sun, national and other holidays)
Reception windows at Osada and Kambara Branches will be set up from Tues. Jul. 1 to Wed. Jul. 31
１
6 Important Points
●Persons who are ineligible for payment do not need to submit application form.
Those applicants confirmed to be taxable for resident tax or dependents of persons taxable for
resident tax (both being ineligible for payment of temporary welfare benefits) will be informed that they
do not meet the necessary criteria.
●Even if receiving two or more pensions, allowances etc. listed in No. 3, the amount of additional
benefits each person can receive is limited to ¥5,000.
●For those persons who can, but have not yet filed for eligibility to receive pensions or allowances
applicable to the additional benefits payment, please file by Sept. 30, 2014.
●For those who wish to receive payment in cash, please see the back page of the Application Guide.
How can I know whether or not I am taxable for resident tax?
Q
For example, if the following apply to you, then you are currently taxable for resident tax:
・If there is a tax amount included in the resident tax column of your salary payment slip (see Reference 1)
A
・If your employment earnings or pension income exceed the Tax Exemption Limit (see Reference 2)
Reference 1
Reference 2
給与支給明細書
年
月分
所属
氏名
Salary Payment Slip
出勤日数
Work Days
勤怠
Attendance 就業時間
Year
Month
欠勤日数
Division
有給休暇
Name
代休日数
Days Absent
Paid Holiday
Comp.. Holiday
早出残業
早朝深夜
Overtime Hours
Special OT
Hours
Work Hours
支給額
Payment
Amount
残業手当
200,000 Overtime Pay
Base Salary
家族手当
Family Allowance
通勤手当
25,000 Commuting All.
住宅手当
12,000 Housing All.
10,000
5,000
計
Total 252,000
健康保険
介護保険
7,000 Nursing
Health Insurance
厚生年金
2,500 Emp. Pension
雇用保険
17,000 Employment. Ins.
15,000
Insurance
控除額
Deductible 所得税
Income Tax
Amount
計
Total
Employment
Total Income Earnings
Amount (¥) Conversion
(¥)
住民税
4,000 Resident Tax
5,400
37,400
No. of dependents
(including spouse)
基本給
Tax Exemption Limit
(In Shizuoka City, if income/earnings
amount is less than shown below, per capita
tax exemption applies)
214,600
Please be cautious of fraudulent attempts to make you
transfer money/provide personal information disguised
as a phone call/postal mail regarding temporary welfare
benefits payment.
0
315,000
1
819,000
965,000
Pension Income
Conversion (¥)
Under 65
Over 65
1,015,000 1,515,000
1,469,000 1,592,000 2,019,000
2
1,134,000 1,879,999 2,012,000 2,334,000
3
1,449,000 2,327,999 2,432,000 2,649,000
4
1,764,000 2,779,999 2,852,000 2,964,000
5
2,079,000 3,227,999 3,272,000 3,279,000
☎
Police Stations:
Shizuoka Chuo
054-250-0110
Shizuoka Minami
054-288-0110
Shimizu
054-366-0110
●Under no circumstances would Shizuoka City, the Ministry of Health, Labor and Welfare or other government
organizations request you to use an ATM (Automated Teller Machine), remit fees etc.
●If you receive a suspicious phone call or postal mail, please contact the Shizuoka City Temporary Welfare Benefits
Office or your nearest police station (alternatively, the police consultation line at #9110) right away.
For inquiries regarding Shizuoka City’s temporary welfare benefits payment:
Call Center
Open:
054–205–1290
9:00am-6:00pm (exc. Sat, Sun, national and other holidays)
Shizuoka City Temporary Welfare Benefits Office
Notice regarding inquiries
Questions involving personal information (i.e.
whether or not you are taxable for resident taxes,
etc.) cannot be answered.
http://www.city.shizuoka.jp/deps/fukusisoumu/kyufukin.html
054-221-1342 ( ? 中国语, Português, English)
２
START
You were registered as a
resident of Shizuoka City as of
Jan. 1, 2014 (reference date).
NO
Please inquire to the municipality you were registered
as of the reference date.
Additionally, persons born after Jan. 2, 2014 and
persons who pass away between Jan. 1 and the
payment decision are not eligible for payment.
※You do not need to submit an application to
Shizuoka City’s Temporary Welfare Benefits Window.
YES
You were not a ward of a public
assistance program as of the
reference date.
NO
Corresponding to revisions in welfare benefits
standards, you do not qualify for temporary welfare
benefits.
※You do not need to submit an application.
NO
Persons who are taxable for FY2014 resident tax do
not qualify for payment.
※ You do not need to submit an application.
NO
Dependents of persons who are taxed FY2014
resident tax do not qualify for payment.
※ You do not need to submit an application.
YES
You are not taxable for FY2014
resident tax (including
municipalities other than
Shizuoka City).
YES
You are not a dependent (see
Note 1) of a person who is taxed
FY2014 resident tax.
YES
It is possible that you qualify for
payment.
Please apply with the provided application
form. Shizuoka City will check whether or not
you qualify for payment (takes 2-3 months).
３
(Note 1) “Dependent” indicates spouses designated as
tax-exempt by the Local Tax Law, spouses with special
spousal tax exemption, dependent family members,
blue-paper family employees, white-paper family
employees etc.
様式第１号（第５条関係）
記入例
臨時福祉給付金支給申請書兼請求書
（宛先）　静岡市長
静岡市
受付印
①
申請・請求者
（代理申請・請求者）
記入日
平成26年　× 月　○　日
〒　×××　－　○○○○
住 所
バーコード
お問い合わせ番号
静岡市葵区追手町×番○号
シズオカ　アオイ
（フリガナ）
静岡　葵
054-×××-○○○○　氏　名
電　話
静
㊞
岡
※申請・請求者は署名又は記名・押印してください。
臨時福祉給付金の支給を受けたいので、静岡市臨時福祉給付金支給事業実施要綱第５条の規定により、次のとおり関係書類を添えて申請しま
す。なお、申請にあたっては裏面の「誓約・同意事項」に誓約・同意します。
また、申請・請求者が「２．申請者一覧」の中にいる場合、同一世帯員は申請、請求及び受給を委任するものとします。
１． 振込先金融機関
下記の金融機関口座（申請・請求者の口座に限ります。）への振込を希望します。
②
金　融　機　関　名
××
銀行番号
1
2
3
4
1.銀行
2.金庫
3.信組
4.信連
支店名
5.農協
6.漁協
本・支店
本・支所 1普通
出張所
○○
7.信漁連
店番号
口座番号
分類
5
6
7
口　座　名　義　人（　カ　ナ　）
（右詰め でお書きください。）
1
2
3
4
5
6
7
2当座
シズオカ　アオイ
※ゆうちょ銀行を選択された場合は、「振込用の店名・預金種目・口座番号(7桁)」（通帳見開き下部に記載）を記入してください。
※長期間入出金のない口座を記入しないでください。
※海外で開設した口座には振込できません。
２． 申請者一覧（世帯員一覧）
①下記一覧に記載されている人は審査に必要となるため、裏面の「誓約・同意事項」に誓約・同意し、押印又は署名してください。
②下記一覧に記載されている人の中で、申請をしない人はＢ欄に「×」を記入してください。
③申請する人の中で、加算に該当する人はＣ欄に該当する番号を記入してください。（番号は左記案内文の「加算対象一覧」を参照。）
③Ａ
氏　名
申請者番号
性　別
生　年　月　日
1
静岡　葵
静
㊞
岡
女
昭和○×年△月□日
2
静岡　駿
静
㊞
岡
男
平成×年○月△日
3
静岡　富士男
静
㊞
岡
男
大正●年□月×日
④
Ｂ
申請しない人
⑤
Ｃ
加算に該当する人
×
①
①裏面の誓約・同意事項
①
After confirming the
を確認した上で氏名等を
pledged/agreed terms
記入・押印してください。
on
the back page,
また、本人確認書類を裏
please write name and
面に貼り付けてください。
affix
seal.
②Please
write the
②上記①の申請・請求者
information
for the
名義の口座を記入してくだ
さい。 account in the
bank
また、通帳やキャッシュ
name
of the
カードの写しを裏面に貼り
applicant/claimant
付けてください。
listed
above in ①.
③
For family members
③一覧に記載されている
listed
here, please affix
人は、裏面の誓約・同意
your
seal after
事項を確認した上で押印
confirming
してください。
pledged/agreed
terms
記載されている人全員の
押印又は署名が必要です。
on
back page.
All persons listed here
must affix seal or write
④支給対象とならない人
signature.
（課税されている人や課
税されている人に扶養さ
④
Please write an “X” in
れている人等）は、×をつ
this column for persons
ineligible
for payment
けてください。
(taxable
persons or
×をつけた人については
dependents
of taxable
審査対象から除外します。
persons,
etc.)
×をつけていない場合は、
Persons
with no “X” in this
全員を審査対象とします
column will be checked for
ので、全員の本人確認書
eligibility, so please attach
類を裏面に添付してくださ
to
the back page
い。
documents confirming
their identity.
＊＊ ＊＊＊＊＊＊＊＊＊＊＊
㊞
⑤加算措置に該当する人
Those eligible for
＊＊ ＊＊＊＊＊＊＊ ＊＊＊＊ ＊＊＊＊＊ ⑤
additional benefits: please
＊＊ ＊＊＊＊＊＊＊＊＊＊＊
㊞
＊＊ ＊＊＊＊＊＊＊ ＊＊＊＊ ＊＊＊＊＊
＊＊ ＊＊＊＊＊＊＊＊＊＊＊
㊞
＊＊ ＊＊＊＊＊＊＊ ＊＊＊＊ ＊＊＊＊＊
＊＊ ＊＊＊＊＊＊＊＊＊＊＊
㊞
＊＊ ＊＊＊＊＊＊＊ ＊＊＊＊ ＊＊＊＊＊
上記一覧の申請者が、一覧に記載されている人以外から扶養されている（又は専従者給与を受け取っている）場合、扶養している人（又は事業主）につい
て記入し、該当する申請者を上記一覧のＡ欄の申請者番号から選択してください。
※下記の人は該当する申請者の審査に必要なため、裏面の「誓約・同意事項」に誓約・同意し、署名又は記名・押印してください。
（　フ　リ　ガ　ナ　）
⑥
性　別
氏　名
シズオカ　キヨシ
静岡　清
⑦
住所　（平成２６年１月１日時点）
※静岡市以外の場合、非課税の証明書を添付してください。
生　年　月　日
明治・大正・昭和・平成
静
㊞
岡
男 ・ 女
×× 年　○ 月　△ 日
左記の人に扶養されている
申請者のＡ欄の申請者番号
２、３
〒□□□－△△△△
東京都千代田区平河町□丁目△番地●号
は、申請書案内文にある
write
pension/allowance
加算対象一覧から、該当
number
for the system you
する年金・手当等の番号
are
enrolled in (listed in
を記入してください。
the
Application Guide).
該当する人がいない場合
Those ineligible for
は、記入しないでください。
additional benefits should
not write anything here.
⑥申請者一覧に記載され
⑥
If you have dependents
ている人のうち、記載され
who
are not listed above
ていない人（世帯外）から
as applicants (that is, they
扶養されている人がいる
are
not in your household),
場合は、記入してください。
please
write their details
here.
⑦世帯外から扶養してい
⑦
If you have an out-of-
る人の住所が静岡市以外
household
dependent
の場合は、当該扶養者の
whose
address is not in
非課税の証明書を裏面に
Shizuoka
City, please
attach
their Tax Exemption
貼り付けてください。
Certificate to back page.
４