how to fill in the application form for the special cash payment (Kusatsu City version)

City of Kusatsu has sent an envelope,in which the application form for Special Cash Payment (100,000yen) is enclosed, to all the residents of Kusatsu city on May 22.
Application Form Example in English (Kusatsu version) PDF

☆how to apply for the payment☆
1. FIll in the form(Example is attached to this page)
2. Attach the copy of residence card and passbook(or cash card) to the form.
3. Put the form in the envelop enclosed and just send it back by post.(No postal stamp needed on the envelope)