<Instruction> Notification Form of Appointment of Tax Agent ( For individuals )
Income Tax Consumption Tax
Cross out “income tax” or
“consumption tax” according to
the tax you will report
The name of your
competent tax office ･Address or former address in Japan or
･Address or location of real estate (incase of real estate transaction)
Date of submission The address other than above (in Japan)
Year Month Date Date of birth
Your Name
Year Month Date
Your Occupation Your Trade name (if any)
1 Tax agent I hereby notify that I have appointed the following
person / corporation as my tax agent.
The domicile or
residence Tax Agent’s address or place of business
Relationship between the tax
Name Tax Agent’s name agent and the taxpayer (if any)
Occupation Occupation Tel
2 The domicile or residence outside of Japan (current address outside of Japan)
3 Cause for appointing the tax agent
4 Matters for 1) “The (planned) date of departure from Japan” or “The date of arrival to Japan”
reference
2) Domestic sourced income
(circle the applicable type of
income or describe the charac-
ter of the income)
3) Other Rent income Capital gains
Any income other than
Business income Employment income the above or the income
of unknown type
The name of Certified public tax accountant
(if any) and his/her phone number
Do not fill in the columns marked with
Guidelines for filling in the Notification Form of Appointment of Tax Agent (For individuals)
1. Taxpayer as individual is required to submit this form when he/she has appointed the tax agent.
2. Appointed tax agent manages following matters exclude “the request for reconsideration to the
Director-General of the National Tax Tribunal” related matters:
1) To make, file and submit documentations such as tax return, application, request and
notification etc. based on the national tax related law.
2) To receive documentations that are issued by the district director of the tax office etc. (include
officers of the tax office etc.).
3) To pay national tax and receive tax refund etc.
3. Submit this notification to the district director of the tax office who has jurisdiction over the tax
payment place.
4. Cross out “income tax” or “consumption tax” according to the tax you will report.
5. In column “1 Tax agent”, if tax agent was corporation, write down each section as follows:
- Address / the location of the head office or principal office
- Name / corporate name and the representative’s name director etc.
- Occupation / details of business
6. In column “2 The domicile or residence outside Japan”, where the tax payer expected to lose
his/her domicile or residence in Japan, write down the foreign domicile or residence.
*When you dismiss your tax agent, submit “Notification of dismissal of tax agent for income
tax/consumption tax”.
*When you submit this form, (1) write down “My-Number” (if you have) and (2) present or attach
the copy of identity verification documents. If you hold duplicate, take care of handling “My-
Number”. For example, by don’t writing “My-Number” in the duplicate etc. (take a step to prevent
copying “My-Number” in case of making and holding duplicate by copying the original etc.).
