江東区不妊治療費助成金交付申請書兼請求書（記入例含む）
healthchildren
This is the application and claim form for Koto Ward's Infertility Treatment Subsidy. Individuals who have received approval for the Tokyo Metropolitan subsidy fill in applicant information and bank details to apply with accompanying documents.
| What | 江東区不妊治療費助成金の交付申請および請求 |
|---|---|
| Who | 東京都の不妊治療費助成事業の助成決定を受けた方 |
| When | 記載なし |
| Where | 記載なし |
| How | 申請書兼請求書に氏名、住所、振込先口座等を記入・押印し、東京都の不妊治療費助成承認決定通知書等の関係書類を添えて提出（消えるボールペン・修正具不可、口座名義人が本人以外等の場合は委任状が必要） |
| Deadline | 記載なし |
| Contact | 03-3647-5906（記入例に記載の電話番号） |
Open the original PDF ↗ 2 pages
Source page: https://www.city.koto.lg.jp/260501/kodomo/ninshinshussan/ninshin/6879.html
Checked 2026-09-09. 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.