YEAR 2009 Provision of Financial Support from Year-end Fundraising Collection (Draft) 英語版 st From the 1 December, the “Year-end Fundraising Collection Drive” began with the aim of “Let’s support each other, creating a warm” Every year donations are received from the goodwill of many citizens, this goodwill is used to provide financial support for those households who live within the city and who have difficulty supporting themselves. The application process will begin this year, so please read the following carefully, and those that are eligible, please apply. 1. Households that are eligible for application (Households which fulfill points ①②③or ①②④) st ① Households living in Hamamatsu city as of 1 September. (Households that are no longer living in Hamamatsu city in December at the time of payment will not be eligible.) ② Households that are not receiving social welfare. ③ All members of the household are exempt from Municipal/Prefectural Resident Tax. ④ Households that have financial reasons for requiring support ※ Households that have savings or income from property/real estate or receiving financial support from family members are not eligible. 2. Method of Application （１）Place to submit your application form Please submit your form in an envelope directly to the Social Worker/Child Committee Member Group in your area, or your nearest Social Welfare Committee Ward Division Centre/Office. 【Documents to submit】 “Application Form for Financial Support from Year-end Fundraising Collection” （ Fill in the applicable boxes and stamp your inkan/personal seal）【Documents to attach】（Ａ）Households which points ①②③ apply to: Copies of documents to prove tax exemption for all members of the household. （At least one of the following: Municipal/Prefectural Resident Taxation Certificate, Certificate of Tax Deduction withheld from regular pay – gensen choshuhyo, Certificate of Tax Deduction from Pension）（Ｂ）Households which points ①②④ apply to: Copies of documents for each household member which show income for the past 3 months (June, July, August) (Payslip, Certificate of Income, Letter of Unemployment, Notification of Pension Transfer etc) （C）Households which are receiving School Expense Subsidies in 2009: Copies of Notification of receiving payment ※Attached documents will not be returned to you. ※Applications without attached documents will not be accepted. （２）Period of submitting application th Please submit application before 30 September (Wed), 2010. (３) Referral about information regarding applications The Hamamatsu City Social Welfare Council may contact the City Hall or the Social Worker Child Committee Member Group to cross reference information regarding your application. 3．Amount of Financial Support Maximum 15,000 Yen (The amount will depend on the amount of donation collected and how many households will receive the Financial Support） 4．Sponsor: Hamamatsu City Social Welfare Committee 5．Cooperative Organisation: Hamamatsu City Social Worker/Child Committee Member Group 6．Method of assessment ・Assessment and decision eligible households will be done at the City Council of Social Welfare Office. ・Households which have been selected will receive the Financial Support from the Social Worker Child Committee Member Group in December. ・Households which have not been selected will be notified by mail in December. 7．Regarding any changes If there are any changes to your address or household situation after you have applied, please contact as soon as possible the Social Worker Child Committee Member Group where you submitted your application. 8．Others For the information guide in Portuguese and English, please visit the (http://www.hamamatsu-syakyou.jp/) ８．Enquiries・Contact details Ward Naka-ku Minami-ku Higashi-ku Nishi-ku Kita-ku Hamakita-ku Tenryu-ku Name of Social Welfare Committee/HQ/Ward Division Centre/Office HQ (Main Office) Naka-ku, Naruko１４０－８ TEL：４５３－０５８０ Hamamatsu Ward Division Centre Naka-ku Naruko-cho,１４０－８ TEL：４５３－０５５３ Higashi-ku Office Higashi-ku, Ryutsumoto-cho,２０－３ Higashi Ward Office 2F TEL：４２２－３７３７ Nishi Ward Division Centre Nishi-ku, Maisaka-cho, Maisaka２７０１－９ TEL：５９６－１７３０ Kita Ward Division Centre Kita-ku, Hosoe-cho, Kiga４５８１ TEL：５２７－２９４１ Inasa Office Kita-ku, Inasa-cho, Iiyano, ２４８－６０ TEL：５４２－３４８６ Mikkabi Office Kita-ku, Mikkabi-cho, Ushi８０３ TEL：５２４－１５１４ Hamakita Ward Division Centre Hamakita-ku, Kobayashi１２７２－１ TEL：５８６－４４９９ Tenryu Ward Division Centre Tenryu-ku, Yamahigashi２８９７ TEL：９２６－０３２２ Haruno Office Tenryu-ku, Haruno-cho, Miyagawa１３３０ TEL：９８９－１２６１ Sakuma Office Tenryu-ku, Sakuma-cho, Chubu１８－１１ TEL：９６５－０２９４ Misakubo Office Tenryu-ku, Misakubo-cho, Okuryoke２９８０－１ TEL：９８２－００４６ Tatsuyama Office Tenryu-ku, Tatsuyama-cho, Tokura７１１－１ TEL：９６９－００８２ website. Application Form for Financial Support from Year-end Fundraising Collection 2009（Draft）【Example】 To the Chairman of Hamamatsu Social Welfare Committee Date of Application: Yr M D I would like to apply for Financial Support as I am an eligible household. (Fill in all boxes) ふりがな Furigana 住はままつたろう Address 申請者氏名（世帯主）Applicant 浜松太郎印 ○ name (Head of Household) 続柄世 Position 所生年月日氏名 Name Date of Birth 〒（○○○－○○○○）浜松市中区成子町１４０－８帯 Applicant Hamamatsu Taro S41．5．5 43 構成 Wife Hanako S42．6．4 42 等 Household Members 電話番号（○○○）○○○－○○○○ Tel No. 年齢職業（正社員・ﾊﾟｰﾄ収入状況（総収入）９月１日等）又は学校名（学（６・７・８月給料額等）年）現在＊非課税世帯の方は記入不要です Age (as Occupation (FT/PT) Income (monthly wage of 1st or School Name for June, July, August) Sep) (Year) Child Hanadai H 6．8．2 15 Child Ichiro H 9．5．6 12 Unemployed 150,000 for June, no income from July Company employee Average 30000 per (PT) month ○ ○ Junior High School３rd grade ○ ○ Elementary School 6th grade ≪Confirmation of Agreement≫ Hamamatsu City Social Welfare Council Chairman As part of the Provision for Financial Support from Year-end Fundraising Collection, I agree to any cross referencing (with the Mayor of Hamamatsu and the relevant Social Worker/Child Committee Member Group) which may be done by the Social Welfare Council Chairman in order to confirm the information contained in the application form. Name of Applicant 浜松太郎印 ◆ Confirmation of Attached Documents (Please circle those that apply) Ａ Copies of documents to prove tax exemption for all members of the household. Municipal/Prefectural Resident Taxation Certificate, Certificate of Tax Deduction withheld from regular pay – gensen choshuhyo, Certificate of Tax Deduction from Pension）Ｂ Copies of documents for each household member which show income for the past 3 months (June, July, August) (Payslip, Certificate of Income, Letter of Unemployment, Notification of Pension Transfer, other) Ｃ Copies of documents to prove households that are receiving School Expense Subsidies in 2009 (Copies of Notification of receiving payment) ≪Reasons for applying for Category B≫ The head of household lost his job from July, and has not had any fixed employment since then, so it is very difficult to support the family. Any personal information recorded on your application form will only be used appropriately by the Social Welfare Committee and will not be distributed to 3rd parties The Financial Support from Year-end Fundraising Collection Proposal will be using the fundraising donation collected from everyone as a financial resource. D e a d l i n e o f s u b m i s s i o n 3 0 t h S e p t e m b e r ( We d ) , 2 0 0 9 Name of Applicant ○○ ○○ 法定地区名地区民生委員児童委員氏名 (民生委員番号 ) 様式１平成２１年度歳末たすけあい援護金申請書申請日：平成社会福祉法人浜松市社会福祉協議会会長年月日宛歳末たすけあい援護金贈呈事業の対象世帯に該当しますので、申請します。（太枠内のみ記入）ふりがな住申請者氏名（世帯主）世続柄印 ○ 氏名生年月日所〒（－）浜松市電話番号（）－収入状況（総収入）年齢職業（正社員・ﾊﾟｰﾄ等）９月１日（６・７・８月給料額等）又は学校名（学年）現在＊非課税世帯の方は記入不要です帯本人構成等 ≪同意確認欄≫ 浜松市社会福祉協議会会長宛私は、歳末たすけあい援護金贈呈事業において、浜松市社会福祉協議会会長が配分審査にかかる申請内容の確認のため、担当地区民生委員児童委員並びに浜松市長に照会することに同意いたします。申請者氏名㊞ ◆添付書類確認欄（該当するものに○をつけてください）Ａ世帯全員の非課税を証明する書類の写し（市・県民税課税証明書、給与等の源泉徴収票、年金の源泉徴収票）Ｂ世帯全員の直近３ヶ月（６，７，８月）の総収入のわかる書類の写し（給与明細書、給与証明書、離職票、年金振込通知書、その他）Ｃ平成２１年度就学援助を受けていることがわかる書類の写し（支給決定の通知の写し） ≪Ｂの場合の申請事由≫ 本申請書にご記入いただく個人情報は、社協事業においてのみ使用し、本会において適正に管理し、無断で第三者への提供はいたしません。歳末たすけあい援護金贈呈事業は、市民の皆様からの募金を財源として実施しております。申請書提出期限平成２１年９月３０日（水）まで代筆者氏名法定地区名地区民生委員児童委員氏名（民生委員番号）