Jibaiseki claim documents

In the following, you will find what documents are necessary to claim payout of CALI (Jibaiseki.) We recommend to see it on a PC or tablet.

●----->>This shows the document you must submit.

◯----->>This shows the document that you need to submit as needed.

No Documents Issuer If you are a Perpetrator If you are a Victim
Injury Death Injury Death
Payout Payout Payout Prior Payout Payout Prior Payout
1 Claim form Claimer  ● ● ● ● ● ●
2 Certificate of Registered Seal Municipal Office ● ● ● ● ● ●
3 Certificate of Traffic Accident   ● ● ● ● ● ●
4 Accident Report Driver or victim ● ● ● ● ● ●
5 Certificate of beacon issuance Municipal Office ◯ ◯ ◯ ◯ ◯ ◯
6 Medical Certificate Doctor ●   ● ●    
7 Statement of Medical Expenses Doctor ●   ●      
8 Receipt of expenses on commuting hospital or hospitalization Victim ● ● ●   ●  
9 Certificate of Lost wages The company you work for  ◯ ◯ ◯   ◯  
10 Receipt of compensation by a perpetrator Receiver ● ●        
11 Out-of-court settlement document and receipt of compensation Parties to the settlement ◯ ◯        
12 Resident Card or Copy of family register Municipal Office ◯   ◯ ◯    
13 Power of Attorney mandator ◯ ◯ ◯ ◯ ◯ ◯
14 Receipt of attendant fee in hospitals  Attendee ◯   ◯      
15 Any certificates proving damages or receipts   ◯ ◯ ◯   ◯  
16 Medical Certificate of Residual Disability Doctor ◯   ◯      
17 Medical Certificate of Death Doctor   ●     ● ●
18 Copy of Family Register Municipal Office    ●     ● ●
19 Statement of Intent on Tentative Payout          ◯   ◯
20 Statement of reasons for not being able to obtain a personal injury accident certificate   ◯ ◯ ◯ ◯ ◯ ◯

1.Claim form of CALI (Jibaiseki)
This is the most critical document for applying the payout of Jibaiseki. It will be safer to ask Certified Administrative Procedures Legal Specialists to make it and confirm the contents so that there is no omission in the request form. However, it's not that difficult to make it if you can understand and write Japanese.

3.Certificate of traffic accident
An application form for issuing a Certificate of Traffic Accident is available at police stations and insurance companies. Fill out the form and mail it to the Japan Safe Driving Center. An issuance fee of 540 yen is required for each Certificate of Traffic Accident. The certificate is one of the most important documents because it explains the fact that there has been a traffic accident.

4.Accident Report
Draw a map of the traffic accident scene. Note that this document is a critical document to judge the percentage of negligence between the victim and perpetrator. The report is also one of the judgment materials for Residual Disability, so write it as detailed as possible. If necessary, Certified Administrative Procedures Legal Specialists can help you to make it.

6, 7 Medical Certificate/Statement of Medical Expenses
Use a designated form of Jibaiseki. When visiting the osteopathic clinic, use the other form called Description of Certificate of Treatment. It is one of the most critical documents because insurance premiums by Jibaiseki will be based on the content of the medical certificate.
There are some hospitals that don't issue Statement of Medical Expenses in the case where you use health insurance for treatment. In this case, you can omit the submission of the Statement of Medical Expenses.
In addition, you can omit the medical fee statement because some hospitals do not issue it if you use health insurance.

8.Receipt of expenses on commuting hospital or hospitalization
Use a designated form of Jibaiseki. Prepare receipts, especially when you used a taxi. If you used a private car, JPY15 per kilometer is a standard. It's not limited only to the transportation fee for commuting hospitals.

9.Certificate of Lost wages
This is a certificate to submit when you claim damages for absence from work.
*If you are a company employee or salaried worker, submit a tax withholding slip.
*If you are sole proprietors and business owners, submit a copy of tax returns with the tax office receipt stamp.
*If you are housekeepers, submit a residence certificate listing all family members.

14.Receipt of attendant fee in hospitals
It is necessary to submit when a close relative accompanied by the victim when commuting to hospitals. However, if the victim is not a child under 12 years old, a doctor's certification (described on the medical certificate) is required. If the participant was absent from work and the lost wages occurred, attach the proof document.

Together with these necessary documents and the original receipt, claim compensation of Jibaiseki the perpetrator has. Note a Certificate of Seal Impression is necessary in the claiming process.