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of Justice,Government of

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APPLICATION FOR PERMISSION TO ENGAGE IN ACTIVIry OTHER THAN THAT
PERMITTED UNDER THE STATUS OF RESIDENCE PREVIOUSLY GRANTED

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To the Director General of the Regional lmmigration Services Bureau

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Pursuant provisions
to the of Paragraph 2 of Article 19 of the lmmigration Control and Refugee Recognition Act, I hereby
apply for permission to engage in activities other than those permitted under the status of residence previously granted.

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Persons, who are able to file for this application following aquisition of landing permission, are limited to those who
have been granted the status of residence of"Student' based on the landing permission (excluding those who have
been granted a period of stay of three (3) months).

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Nationality / Region

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Date of Birth
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Month
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Day

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Name (in English)

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Sex l\ilale

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Signature of the applicant / Date of filling in this form

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