Student Affairs SectionWaseda University

Student Compensation System (Compensation for Injury)

Application formats

Please download and use them as necessary.

*Documents filled out with a pencil or pen using special ink that is erased with friction, etc. shall not be accepted.

Application documents required to be submitted before activities

You must submit the application document below to the Student Affairs Section for all activities by 7 days before the activity start date excluding closed days (excluding Saturdays/Sundays/holidays/vacations) (the deadline must be strictly followed).

Click here to learn how to apply.

*Applications are accepted on an academic year basis. For activities that cross over from one academic year to another, you will need to submit another application at the end of the academic year for the new academic year on or after April 1.

*You may also submit the official trip application for an official trip for an academic conference/research in advance in place of the above application. Refer to the “Research Expense Execution Manual” for details.

=> For compensation during extracurricular activities, submit this application to the Student Affairs Section by 7 days before the activity start date excluding closed days (excluding Saturdays/Sundays/holidays/vacations) (the deadline must be strictly followed).

Application documents required to be submitted in case of an accident

Documents to be submitted immediately after the accident

Within 30 days of the accident, the following (1) must be submitted.
*Only if more than 31 days have passed since the accident, (2) must be submitted in addition to (1).

(1) Student Compensation System (Compensation for Injury) Accident Report

-All applicants are required to submit this form.
-There are two types of accident reports, including the report for traffic accidents (during commuting or during transportation between facilities) and the report for accidents other than traffic accidents.
-In case of a serious accident, such as an accident involving death, a different procedure will be required. Please immediately contact the Student Affairs Section.

(2) Statement of Reasons for Delayed Accident Report

-This shall be submitted only if you are submitting the accident application 30 days past the accident date.

Documents to be submitted after completion of treatment

After completion of treatment, the following items (3) to (7) must be submitted.
*Documents to be submitted will vary depending on the circumstances of your injury. Please see below for details.

(3) Application for Injury Compensation

-All applicants are required to submit this form.

(4) Treatment Report

-If “(6) Medical Certificate” is submitted, this document will not need to be submitted.

(5) Receipts issued by the medical institute (original or photocopy)

-If “(6) Medical Certificate” is submitted, this document will not need to be submitted.

(6) Medical Certificate (original or photocopy)

-If this is submitted, “(4) Treatment Report” and “(6) Receipts issued by the medical institute” will not need to be submitted.
-If the compensation claim amount (amount received as the compensation) exceeds 100,000 yen, this must be submitted.
-A medical certificate that is not in the above prescribed format can be accepted, but it must clearly indicate the number of days of hospital visits and the length of hospitalization.

*Refer to here for the compensation types and amounts

(7) Other

Depending on the situation, we may ask you to submit documents in addition to the documents (1) through (6) above.

In case of a traffic accident (during commuting or during transportation between facilities)

The documents below shall be required.

Traffic accident certificate (original or photocopy)/copy of commuter ticket (for those commuting on train)/copy of license (in case of an accident involving a motorcycle/automobile)

In case of any inconsistency between the Japanese version and the English version, the Japanese version shall prevail.

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