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新型コロナウイルス予防接種申請書兼請求書
healthadmin
This is an application and claim form for residents of Katsushika Ward to receive subsidies for COVID-19 vaccination costs. Applicants must fill in the required information, attach a receipt of their out-of-pocket expenses, and submit the form by mail or in person at the local health office. The submission address is 〒125-0062 Katsushika-ku Aoto 4-15-14, Health Plaza Katsushika 2nd floor.
| What | 新型コロナウイルス予防接種費助成事業の申請書兼請求書 |
|---|---|
| Who | 葛飾区の住民 |
| When | 記載なし |
| Where | 〒125-0062 葛飾区青戸4-15-14 健康プラザかつしか２階 地域保健課 地域医療係 |
| How | フォームに必要事項を記入し、自己負担金の領収書を添付して、郵送または地域保健課窓口へ提出する |
| Deadline | 記載なし |
| Contact | 03-3602-1231 |
Open the original PDF ↗ 1 pages
Source page: https://www.city.katsushika.lg.jp/kenkou/1000050/1001791/1001852.html
Checked 2026-11-01. This page restates the PDF in a fixed structure; nothing is added or removed. Where the PDF does not say, the field reads "not stated". The original Japanese PDF is authoritative — confirm dates and conditions there.