How to Fill in the Application Form and Test Voucher

* Fill in the information required in the boxed areas of the Application Form, and submit them to the
local host institution.
* Information is duplicated from Application Form [A] onto the Test Voucher, so use a b allpoint pen
and apply pressure when writing.
* Clearly write numbers and alphabet according to the samples.
CD Test Level
In box CD. write the number indicating the level of the test you are going to take.
(See "Contents of the Test" on page II.)

CT) Test Site

In box @. write the name of the city where you are going to take the test.

In box ®. clearly write your name in English capital letters, following the samples below and on
the next page. Please use 26 English characters only due to computer data entry system. Refrain
from using special characters (e.g. o (umlaut), a etc.). Leave one box blank between your given
name, middle name, and family name. Make sure your name is written correctly and clearly,
because it will be printed on the "Certificate of Result and Scores" and "Certificate of Japanese
• Language Proficiency" as written there. (Write your first, middle, and family names in the order
you normally follow.)
[ai EnglM characters you can use] [ Incorrect Examples]

IA�B C D�E�F G H�I J K L�MI @--[£] l:©--[J @--[§]

IN!O P!Q!R!S!T U!V!WX�Y�ZI @--[BJ ®--� ® ®
[Example]
Lucy Maria Boston
[CorrectExample]

[J: < �L,��JJ n

I correctExample]

I��' lt-�lolY&}�IRl; Ajelols r OI' II IIIIII I

Leave one space between
1
Write clearly. names.
[J: < �L,��JJ n
I correctExample]

]LluldYI IMIAIRl 1IAI IBlolsl1 lolNI I I I I I I I I I I I I I I I I I I I I I

Ij t t t
,,

Name
I'�
�

"O" and "D" , "L" and "I'' , or "T" and "I'' ,

and other similar-looking letters.
[ Not e]

If your name is over 40 letters long, try shortening your name by using initials. In any case, you
must leave one space between given name, middle name, and family name.

Maria Charlotte Oranienburg von Hohenstauffen� /t;O):t��

[CorrectExample]

® MARIA C. ORANIENBURG- VON HOHENSTAUFFEN

�� f-----"-����������������������������----'------l
Name

[ In correctExample]
��MARIA CHARLOTTE ORANIENBURq VON �OHENST um�
Name

----------,
o not use the margin
�[d::_<_t.i;�"L�'-·�' ����" �Inc� o
� rr � E
_ e� ct _ p� �le]_ �-D� � _ � � _ � � _ � � - � � ·����������� l
_ x� �am
® MARlACHAf<LOTTEORA IENBURff- o HoHENSTAu FE
�� ,........_��...._._������-�������.._��+--"-�������__.__,
Name

Leave one space between names.

@ •Gender

In box ®. check "Male" or "Female."

 Write the numbers of the year, month, and date of your
birth.
[Example] If you are a female and your date of birth is August 17, 1985, write :

®
ttlJIJ
Gender Male
� D � rJ Female ✓
®
1:cffoRB
Date of Birth
�
Year r
'

9 8 15
'
'
'
'
'
'
'
'

'
'
,El
Month
''

0 8
''
''
''
B
Day r 7
Write "O" for single-

1011121314-l5161718l<tl digit months.

® 8-digi t passcode for Online Test Results Announcement

Please decide on an 8-digit passcode and write it down. Be sure to use only numbers, not letters.
Jj :t � �'
[)!� Note]
(4) Online Test Results Announcement will be available on the JLPT website at https://
www.jlpt.jp/e/ in the end of January 2023. An 8-digit passcode (numbers only) is required to see your test
result online. Please be sure to keep your copy of Application Form [g (For the applicant) so as not to
forget your passcode.
Please note that:
(1) if you wrote 7 digits or less numbers,
(2) if you wrote letters in the column,
(3) if you did not write anything in the column, or
(4) if you did not clearly write numbers ( pay attention to "l and 7" and "O and 6" etc. ) as listed in
"Correct Example" below,
a passcode will not be set up for you, and you will not be able to see your test result online.

I I I I 13121114-I I/\.+ I 3181 BIf 5 l1nl 3 I 2 1

[� < �L '��JJ Incorrect Example]
f
+ Do not use letters.
Fill in all 8 digits.
(J)Native Language
Choose the appropriate code number from the list of "NATIVE LANGUAGE CODES" and write it
in the boxes. If your native language is not on the list, enter 000 in the boxes. If you have two or
more native languages, select only one.
NATIVE LANGUAGE CODES
NATIVE LANGUAGE
CODE
ASIA 7-'V7-':ltll�
101 Assamese (77 -lj- hffi)
102 Baluchi (,{Jv·nlf)
103 Bengali ("';, :lfivffi)
104 Bihari (1!1,-1v1ilf)
106 Cebuano (-1!'1'7 ,/1i!f)
107 Chinese (4'00ffil
143 Dhivehi (7'1"'�W)
144 Dzongkha (:.r✓:11\i!f)
408 English (�jj!f)
411 French (77;,;,,ffi)
108 Gujarati Wo-''\'7 rffi)
109 Hindi (�;,71ffi)
110 Ilocano (1a:11 ,1 ffi)
111 Indonesian <1;,r::r--:;7\i!fl
112 Japanese (B#\i!f)
113 Javanese (:l'\''7ffi)
114 Kannada (Kanarese) (71 T 7ffi)
115 Kashmiri (:11 Vs -Jv!lf)
118 Khmer (Kampuchean) (7,,<-1vffi)
119 Korean <•oo - fflflfffil
120 Kurdish (71vrlllfl
121 Lao (7:t7-ffi)
122 Malay (7v-ll!f)
123 Malayalam (77,'-72'1i!f)
124 Marathi (77-T1-1i!f)
125 Manipuri (Meeteilol) (7.::.7'-Jv\i!f)
117 Mongolian (-1:;,:t1vlllf)
105 Myanmar (:,,"' ;,7-1i!f)
126 Nepali (::t--1�-1v1ilf)
127 Oriya (:t- 'J '\'\i!f)
128 Pilipino (J!lJ ]!,J\jlf)
129 Punjabi (,{ ✓ 1/ '\''1'ffi)
130 Pushtu (,{ 1/.:,. I-ffi)
131 Rajasthani (7-oJ'\';,,7.::.ffi)
132 Sindhi < 1/;,rffil
133 Sinhalese (:;;,;,7ffi)
134 Sundanese (;,,✓ '/'ll!f)
135 Tamil (7:,,-1v1ilf)
136 Tatar (77-1villf)
137 Telugu (Tiv:7°.llf)
138 Thai (71ffi)
139 Tibetan ( 7"'°' 7 f- ffi)
140 Uighur (".71 7· Jvffi)
141 Urdu (".7Jvr?-ffil
142 Vietnamese (,-..: 1--:t- .t-1i!f)

® Address
Write the address where you are sure to receive mails.

Name of institution where you are studying (or studied) Japanese language
®
In the blank space, write the name of the institution where you are either currently studying
Japanese language or where you have studied in the past.

Place where you are learning Japanese

Fill in the number of the one item that describes where you are learning Japanese.
1 . learning Japanese at elementary school (primary education)
2. learning Japanese at middle school or high school (secondary education)
3. majoring in Japanese at university or graduate school (higher education)
4. learning but not majoring in Japanese at university or graduate school (higher education)
5. learning Japanese at some other educational institution (such as foreign language schools)
6. not learning Japanese at the educational institutions listed in 1 through 5 above
@ Reason for taking this exam
Fill in the number of the one item that best describes your reason for taking this exam.

1. necessary for admission into university or graduate school in own country

necessary for admission into university or graduate school in Japan
2.
necessary for admission or as proof of proficiency for other educational institution in own
3. country

4. necessary for admission or as proof of proficiency for other educational institution in Japan
5. useful for work or will be useful in order to attain employment, secure salary increase or
promotion in own country
6. useful for work or will be useful in order to attain employment, secure salary increase
or promotion in Japan

7 . to measure my own level of proficiency for reasons other than 1 through 6 above

8. other
@ Occupation

Fill in the number of the one item that best describes your occupation.
1 . elementary school student (primary education)
2. middle school or high school student (secondary education) ➔
university or graduate school student (higher education) @
3. Go to
question
4. No.@
student of some other educational institution (such as foreign language school)

5.
employed (company employee, public servant,
educator, self-employed, etc.)
➔ @Go to question No.@

6. other ....+ ®Go to question No.@

r----------------------------------------------------------------------,
I I

! Question No. 13 must be answered only by those who chose 5 in No. 12 above. I
L----------------------------------------------------------------------�
I
@ Occupational details
Fill in the number of the one item that applies to you the most.
1. Using Japanese while working as a Japanese language teacher at educational institution
2. Using Japanese while working as a public servant
3 . Using Japanese while working as a company employee, such as in the manufacturing,
building, or information and Communication industries
4. Using Japanese while working as an employee in the service, tourism, or hospitality
industries.
5. Using Japanese at a job other than 1 through 4 above
6. do not use Japanese while working

r----------------------------------------------------------------------,
I I

! Questions No. 14 through No. 30 must be answered by all applicants. I

L----------------------------------------------------------------------�
I
@ Media via which you come into contact with Japanese language
Through which media do you listen or read Japanese outside of the class? Circle the number
of the following items that apply to you. If multiple items apply, circle all applicable items.

1:r1v <·Ji.
1. =1-;i_ -�*1����--� TV news program and documentaries
11)-t'
2. �5Y (::P=���<) drama (excluding animation)
3. ::P=� animation
1.,/..,.1:A, if-, I, -; A, -IJ' 11)-t'
4. �Jr� · �� (�ifili��<) newspapers and magazines (excluding manga)
5. * (�l����<)
"Iv Id "' ls 11)-f:
books (excluding textbooks)
manga
$ t
7. r:'.J I 7'-!j---{ f--O)�c$ articles on websites
tc
8. -t"O)ftB other
do not come into contact with Japanese language
outside of class
 eThe person with whom you usually communicate in Japanese
With whom and how do you usually communicate in Japanese? Circle the number (s) of the following
items that apply to you. If multiple items apply, circle all applicable items.

@) With a teacher

talking in Japanese with the teacher

��O)�j§�lif.l<
<tA-<t<• IIH �
2. listening to what the teacher says in Japanese
3. reading what the teacher wrote in Japanese
4. writing in Japanese to the teacher
none of the above

@ With friends

talking in Japanese with friends

listening to what friends say in Japanese
reading what friends wrote in Japanese
writing in Japanese to friends
none of the above

@ With family

talking in Japanese with the family

listening to what the family say in Japanese
reading what the family wrote in Japanese
writing in Japanese to the family
none of the above

@ With a supervisor
1 . ...tqJc�g
Cd L, Ii>;:
talking in Japanese with the supervisor
_tq]O)��OO<
ti) l, IIH �
2. listening to what the supervisor says in Japanese
3. reading what the supervisor wrote in Japanese
4. writing in Japanese to the supervisor
none of the above

@) With colleagues

talking in Japanese with colleagues

listening to what colleagues say in Japanese
reading what colleagues wrote in Japanese
writing in Japanese to colleagues
none of the above

- 28-
@) With customers

talking in Japanese with customers

listening to what customers say in Japanese
reading what customers wrote in Japanese
writing in Japanese to customers
none of the above

How many times have you taken JLPT, excluding this time? Write the number in the box for each
level. Circle "Pass" or "Fail" at each level about the last JLPT you took. Leave it blank if you have
not taken that level before. If you have taken it 9 times or more, write 9.
® Photos

In box® of the Test Voucher and the Test Voucher (Copy), attach a portrait (full-face) photo.

OAcceptable photos X Unacceptable photos

· 3~4cm high x 3cm wide · Photos larger or smaller than 3~4cm x 3cm
· Taken within the past 6 months · Taken against a non-solid background (dark background)
· Name and date of birth are written on · Blurred photos (too dark)
the back · Your eyes are closed
· May be black and white or color · You are wearing a hat
May be taken with a digital camera (be · You are wearing sunglasses
sure to print on photographic paper) · Your hands are in photos
· Borderless photos · Snapshots, such as taken together with other people
· Your face is too small or too big relative to the photo size
· Color photocopies
· Photos printed on ordinary copy paper
® Signature
Write your signature and the date in the space provided if you understand and agree to all the condi­
tions and contents of this Test Guide. If it is di:fficult for the applicant to sign the Application Form for
the following reasons, a representative can sign on behalf of the applicant. A signature is required in
order to apply for this test.
-Underage applicants
-Applicants with disabilities
@ Mailing Address

Write your address in English characters or your nativ e language where you are sure to receive
your certificates. Depending on the host institution, the certificates may be handed directly to you at
a specified place. For further details, please contact the applicant's host institution.
 Application Form Example

See p.21-30 for details.

( tU]ic�"il�t:f®-sii,:-::x)"f(,t 15-"\-V=ti t.:t5L )◊) z<
See p. 18'I·t you have a phys1ca
. l d.1sabT
1 1ty or other 1mpa1rments.
. .
Write the name
of the city where
you will take the
- 7tY5-1 YiiimfflOOfilffii(BffiO)ij�O)iij.) �,L )'[ < t::.t5L )o
Write an 8-digit passcode (numbers only) for Online Test Results
Announcement.
r
••
test. �Do not fill in this

[;Z]
20221lo m2@ B ;;ts:�ltllJJfiitUi:

(;!U;;li�ffl)
The Japanese-Language Proficiency Test in 2022 (December) 1:�J:.O?�cll >i-:li\":i! part.
[A]
Request Special
For the Japan � � Testing
Write "O" here
Foundation Application Form Accommodations
1:�*J:/;J2-'<-::-'l:il!,� ,1:�llfj!JneaaJ..1'l >i-�'Jtl:, ;!;:;tl',J:l;Jq:,;,.j[ l.., < taJ.. L -C < t!.� �'o if the month or
Fill in the information required in boxe:l areas as shown in the .. Application Form Example" on page 2 of the Test Guide. date is
11:#"J,Jl B Date Received I I Jl Month B Day +--

II ct B I (f!).Il.)I I I I I I
between 1 and
2 0 2 2"1S
Write the 11:.ll!tffi'-l} Examinee Registration Number
number
indicating the
CD1i:!i!tv"'1�
Test Level N (1)11:Jl!tJI!! �PUNE
Test Site
2 2I 1
(1']Y)
f+
(Jjfi) (Jldl) r::1,,,,.,.! l(IIIAH)
9.

level of the test ®

i\nu
Tl, NI, wl, lrlA YIAI I I I I I
�:!��Q)h'N!!-o-C(l::t<o,, i\liulJ:'CQ)tllJl:!lf,H1.t:lli�l:�11i�· · ·· "
IIIII I
you will take.
Name 11' � �,;,25:11:,;, u.:,;, English capital letters. Your name will be printed on the cer�ficates as you write. - See p.24-25.
Gender !ll D j( �
® !t l'Jl B
I Dat1 91 Birth IYfar I q q slnl' g
®
1
Month 0 � I Day 0
tt�IJ Male Female V
l ! sl'
Print your name
®.-:,;;1 :,,11;9Jli!flff'i11-!}(8lii0lli'a'Olh)
8-digit passcode (numbers only) for
Online Test Results Announcement
I '! 3 '! 4-J
' . ' '0' . !1!
q 2. 4-, H Native Language I 1! 1 1
ffi'll!!
1

-
only in 26 ® Street/Suburb Your address
m·ffl City/State Your CITY and STATE NAME
See p.25-29.
English capital 00 · ll!!l!l Country/Area lNDIA
-Ii ili
1111Jl!ffi'-l} Postal Code Your postal code
letters. Address
'llt\lliffi'-',- Telephone No. 021-'I0-2603
flt'f-;<-Jv E-mail Your Mail id
Leave one ® s�uf!i?��fd) 1y:g��L���;; are
u Where you study
3
@1l:.li!t§fl'J (1~87)>"1-?il!!.&:)
? � Leave it blank if
box blank
@) B*llf"'l'l!f0)/1, (l ~6,H, 10;l!l.&:)
Place of learning Japanese (Choose a number from 1 to 6) j Reason for taking this exam (Choose a number from I to 8)
@ JIit,!, (1-6�'"10;l!l.&:) I 3
@ Jll,i,O)jilfj (I - 6 ,i,"I 0;!.&:)
� you have not taken
each level of JLPT.
Occupation (Choose a number from 1 to 6) Occupational details (Choose a number from 1 to 6)
between �
I@ 4 1@1@ 1 I s 9
@ B*l!il:O)�ltilllH.f,:
I I
2
Media via which you come into contact with Japanese language
�< If you have taken
names. IJ:'l:i" H, -IP(

m it 9 times or more.
.b-CIJ:£ &;,:,,
Speaking Listening Reading Writing None of the above

�
m
® 9£;1:. with a teacher (2) (.3) (.4) 5
B:,fcilliHl!!/ll @) 1.;:A with friends (2} 3 4 5 � write 9.
�
i"-!>ffl'f
The person with @ 'fc/jj( with family 1 2 3 4 's
whom you usually @)
communicate in
J: Ji) with a supervisor 1 2 3 4 5 �
Japanese @) [ii)fl with colleagues I 2 3 4 5 14-
® llifr with customers I 2 3 4 l5 �
Nl/lBUll N2/1B2a N4/IB3a N5/IB4a
"
2.I "'
..t.;1Levell J:,xLevelZ ..t.;1:Level3 .g:Level4

®I I s!..
�:!<11:.ll!tlIDli:
@Ir I ®I. ®I
! ! leJ
Times of taking JLPT @ T .. T es Times Times

:limO)il"'a ®
I: 1t(Pass) ®11: 1t(Pass) )
@I
II: 1t (Pass) @II: it (Pass)
Write your signature
Pass/Fail of the last time at each level i!f (Fail) @ 2 �:i:: 2: i!i (Fail) 2 : i!f (Fail) 2: i!i (Fail)
_:O)�i��,::i:�--c�1.,-t.-s:-c0)-:. c �iiit..., !iilit...tJ�"Z'�i�¥ L..i2>JJ.ii"
? :

® o
and the date.
_.. I, by submitting this form. understand and agree to all the conditions and contents of the Test Guide.
\.,J:lO�• t>-:flt
I+
!fi'r/Signature B#/Date

/
�
@) MAILING 1',]llj Mr. Write your name
ADDRESS Name
�
Your Name and address
Do not cut off. ��� :W:Ji�!H!Hfl
Your Address correctly and
*tmttm ft@i clearly.
Address (Postal Code) your postal code (Country/Area) INDIA
(For sending the test (Tel.) Your Mobile Number
results) /
1: ll9i ffi' -1,- I IB I I I I I I I
212
('I') (:r.1Jr) (00·:ltli.bt) (,>;i<jfi) 1"1lll)
�
(VXJ'.-)
I I I
(ffllA.'t) Do not fill in
this part.
�

Your signature is required in order to apply for the test.

(Please refer to P.30 for details.)
L; � t:t Iv O � -:> Test Voucher
2022:r.i/v t.:�'21.N' 1:11/v �<I)? tJ J: ( lAt Iv
The Japanese-Language Proficiency Test in 2022 (December)

Photo
l:,191ltlvU-J: '? C•ld>•A,/t,,
(3~4cmx 3cm) Test Voucher Seal or Signature

T PUNE

.;,,"'" st�
Gender Male D l!A,�
Female �
n -tf't,,QA.,il!-?(J!
Date of Birth
t.l.A.
Year q q 5 -::,�
Month 0
0
Day

Please make sure that all the necessary information is clearly legible. If there is any mistake in your name, gender, or date of birth,
notify the local host institution by June 3, 2022. Please note that no change of the test site or the test level will be allowed
after the Application Form has been submitted.
For 'Listening' Section, you are not allowed to enter the test room at any time after the CD/tape is set to run. For other sec­
tions. enter the room no later than 10 minutes after the test starts.
On the day of the test, you should bring your own writing utensils(black mectium-soft(No2 or HB)pencils and a plastic eraser)
and a photo identification in addition to this Test Voucher.

l, � ? ;:: ? l5 fJ> A, Time designated for assembling [; t; ,t A,IJ J:? Test Fee

2022.12.4 J:: o: t 1 r.J')

Do not fill in December 4, 2022 (Sunday)

this part. l, tt f.,tJ•�' [;J:? Name and Address of Test Center

Do not fill in
l,;�IJJ:?�'f.,/-lj-,{ ✓
Seal or Signature this part.

l!< l.At /vO) t/-0) b t, b 0)

tl9>1t/vU-J: 1,< o�•�MJ-:::>
ltL�tr, L� L/v-:::>�<l)Jf..S:/v
LJ: ?��'LJ:

ti,,,tA..V�JV, ti,,ltA...'t, ti,,�tA...i!A....:.""-j, �t;l, -tt._,\-<-:::>, ,tti,,\t.iA...:6t-::>7.Jli t.:t!Li.-\"C"i":6�"

td!t.,<,),1•!:�li t-ot.,�;;,,u: tt A, G < VC<t!�>•o l-""��1;1:11;;•0J:-o;o'°t'To
t .. 1tA,1,,-<1v!: t .. 1tA,t,11; ;;,;!_-l,;: !:;6• "t'I! ,t,tA,o
l,� A,#�t-•t•"-�•<tt,),�"t'<ti!�
!0.S: A, 1,t,-j M<tttcG "-'l>IC lh>ttj,t A,o
rt.• 'j ;;,pJ l,ltA,li CD!r-7'n< Ii ti-o t.: G ""-'l>I: lil•tti<tA,o

L; � t:t Iv O � -:> (0"/J' ;l) Test Voucher (Copy)

2022:r.llv t.:�'21.1'�' 1:11/v�<I)? tJ J: ( l..lt/v /:�;�.,i
\)i?)t,�1
The Japanese-Language Proficiency Test in 2022 (December)
R�e\\lt eo�7
Photo
l.'.,191ltlvU-J: 1(v-n,x.) C•9d>•A,/tf>
(3~4cmx 3cm) Seal or Signature
Test Voucher (Copy)
Attach your
photo � PUNE tA,i!�A,�:::: 1�· E=
-,t�,.�li- = ·•�•• R�e g1�·s1r�ati o
· n Numbe r
I I I BI I I I I I I , ---,= ,= i- 'r r r "-', ==r�
I I
��
§
'-'--i
(should be a 2 2

full-face
portrait) here.

,t\v(-:, ilt� □ ;,u

Gender Male Female �
n -ltt,,>:QA,i)f "'.) 7.J
Date of Birth
t.l.A.
Year I q q 5 -::,�
Month 0
0
Day 0 g If any information on your
Test Voucher differs fro m
t191,tA,v..-..::,1,,, t191ltA.-'t, t1911tA.-l;!A,.:.""-j, �i.L -tti,,,.r{ Please make sure that all the necessary information is
-:'.), -ttv,nA.,t1t-::>111:1 f,:t.::"Lli'"C'i°il>c, t.:t.::"L< fti,,,,t �ii t-::> L clearly legible. If there is any mistake in your name. gender,
or date of birth, notify the local host institution by
your Application Form, notify
�;o•A,I: h,A, G < vc < t!! ''o l-""I!�lill;o'".>J:-o;o'°t'T o
t .. ltA, t.,--<Jv!: t .. ltA,t,li ;o,;!_,o;: !:;ot "t'I! j,tA,o November 4, 2022. Please note that no change of the test site
or the test level will be allowed after the Application Form your local host institution at
l,ltA,;ot Ii t ;17., t;o,A,J: M<tt,),\>"t' < i:!!l'o has been submitted.
10.s:,;,,, t, ,j M<tttcG "-'l>I: lic,tt,t-<t,;,o For 'Listening' Section, you are not allowed to enter the least one month prior to the
rt.. ');;,,,J l-ltA,ii CD/r-7':6' Ii t,t-ot.:G "-'l>IC li>>ttt test room at any time after the CD/tape is set to run. For
-ltA,o other sections. enter the room no later than 10 minutes after Test Date.
the test starts.