How to fill out Registration Update Form for Child

Registration Update Form for Child Allowance (jido teate genkyo todoke 児童手当 現況届)
If you receive a mail in a white envelope like this, open it up.
Fill the necessary part as below.
DATE OF SUBMISSION [yyyy/mm/dd]
NAME OF RECIPIENT AND SEAL (SIGNATURE)
PHONE NUMBER
NAME OF SPOUSE AND SEAL
(SIGNATURE)
ATTACH A COPY OF RECIPIENT’S
HEALTH INSURANCE CARD (Except NHI
member) HERE
ADDRESS (In case your spouse’s address is different)
Circle 有 if you raise the child
by yourself. If not, choose 無.
Circle ア(the first one) if you join
an employees’ health insurance.
Circle ウ (the third one) if you
are a NHI member.
Circle 同一 if the child is your
own child, if not, choose 維持.
RELATIONSHIP:
Write 子 here.
Circle 同 if your child lives
with you, or 別 if not.