Without a koseki, a person's birth, parentage, and legal status cannot be verified, and although municipalities maintain the records, people without them often slip through administrative cracks. NPO groups supporting unregistered individuals report receiving more than 30 consultations each year. Many cases stem from complex family circumstances. One woman in Saitama, Misa, was born to a Filipino mother who fled an abusive husband. Filing a birth notification would have alerted the husband to her location, so Misa grew up without a registry, leaving her unable to obtain a resident record and repeatedly turned away from employers who requested documentation. Now a single mother of two, she has struggled for two years to secure stable work. "There were times when my wallet was completely empty. I couldn't even buy food my kids liked," she said. Others suffer in silence due to lack of health insurance. A man in Yamaguchi, identified as A, said he avoided hospitals because, without a registry, he could not receive a health insurance card and had to pay full medical costs out of pocket. "Even when something hurt, I just took over-the-counter painkillers," he recalled.