Application for COVID-19 Vaccination Certificate

COVID-19 vaccination certificates (Vaccine Passport) will be issued for those who have been vaccinated as proof for travelling abroad. 
For the time being, this certificate will be issued to only those who actually plan to travel abroad.   

Main certification details

Information concerning vaccinated person

Name, Date of Birth, Nationality, Passport Number

Vaccination records

  • Vaccine maker
  • Vaccine product name and its product number


Those who have been vaccinated by using the vaccination coupon tickets issued by Oizumi Town are eligible.
(Those who have been registered in the Oizumi Town as of the day of the vaccinations.)   

Required documents for application

Please submit the following documents.

  1. Application form
  2. A copy of your Passport (The page with your passport number is required.) 
  3. Your identification document
  4. A copy of your vaccination completion certificate (Sesshu-Zumi-Sho) or Vaccination Record (Sesshu-Kiroku-Sho)

If you need it by mail, a self-addressed envelope is required. (Please write your name and address and affix an 84 yen stamp).  

When someone other than the applicant is applying on behalf of the applicant

The following documents in addition to the above 1~4 are required. 

  • Letter of attorney
  • Proxy’s identification documents

If you are using a former name or an alias on your passport

The following documents in addition to the above 1~4 are required. 

Documents confirming your former name or alias (Driver’s license card, Residence Certificate (Jyumin Hyo), etc.)

Application Method 

At the counter

Applications are accepted at Health Promotion Division (Kenko-Zukuri-ka) at the 1st counter in Oizumi Town Health & Welfare General Center.

By mail

Send to:
2465 Yoshida Oizumi-machi, Oura-gun, Gunma
Attention to: Health Promotion Division (Kenko-Zukuri-ka)

Time and cost to issue

It takes about one week from the date the application is received to the date of issuance.
It is free of charge.

Contact Information

About the system

If you have any general inquiries about COVID-19  Vaccination Certificate (Vaccine Passport), please contact COVID-19 Call Center (0120-761770) of Ministry of Health, Labour and Welfare.

About issuance

Health Promotion Division
Phone: 0276-62-2121
Counter: The 1st counter in Health Welfare General Center