一the name, domicile (the residence if the person has no domicile in Japan, and the domicile or residence outside Japan if the person has neither domicile nor residence in Japan; the same applies hereinafter in this Chapter) and individual number (for a person who has no individual number, the name and domicile; the same applies hereinafter in this Chapter) of the person who submits the return under Article 194, paragraph (1) of the Act (hereinafter referred to as the "filer" in this paragraph);

二the date of birth and domicile of the spouse for Withholding deduction, and the estimated amount of total income prescribed in Article 2, paragraph (1), item (xxx) (Definitions) of the Act (hereinafter referred to as "total income" in this Chapter);

三the date of birth, domicile and relationship to the filer of the relative for Withholding deduction, and the estimated amount of total income;

四if there is a Person with a Disability among the spouse in the same household (excluding the spouse for Withholding deduction) or Dependents (excluding relatives for Withholding deduction), the domicile of that person and the relationship to the filer (for a spouse in the same household, the domicile), and the estimated amount of total income;

五if, among the persons deemed under Article 85, paragraphs (4) to (6) (Time of Determination of Dependents and Similar Persons) of the Act to fall under the spouse in the same household of a Resident other than the filer (hereinafter referred to as the "other Resident" in this item), the spouse prescribed in Article 83-2, paragraph (1) (Special Spousal Deduction) of the Act whose living expenses are paid from the same resources (hereinafter referred to as the "spouse eligible for special deduction" in this item), or a Dependent or the specified relative prescribed in Article 84-2, paragraph (1) (Special Deduction for Specified Relatives) of the Act (hereinafter referred to as the "specified relative" in this item), there is a Claimable Spouse or other spouse in the same household of that other Resident (limited to a person who falls under the preceding item; the same applies hereinafter in this item), or a spouse eligible for special deduction, or a Claimable Dependent or other Dependent (limited to a person who falls under the preceding item; the same applies hereinafter in this item), or a specified relative, a statement to that effect, the name of the other Resident and the relationship to the filer, and the name, domicile and relationship to the filer of the person whom the other Resident treats as his/her Claimable Spouse or other spouse in the same household, spouse eligible for special deduction, Claimable Dependent or other Dependent, or specified relative;

六if the return under Article 195, paragraph (1) (Return for Deduction for Dependents, etc. Regarding Secondary Salaries) of the Act has been submitted in that year, a statement to that effect;

七any other matters for reference.

一the name, domicile and individual number of the person who submits the return under Article 194, paragraph (3) of the Act;

二the name or corporate name of the payer of the salary or other wage in Article 194, paragraph (1) of the Act through whom the return is to be submitted under paragraph (3) of that Article;

三the following matters in the case where the person has changed employment in the middle of the year, and in the case where the payer of a secondary salary has become the payer of the primary salary in the middle of the year:

イif there is salary or other wage prescribed in Article 28, paragraph (1) (Salary Income) of the Act (hereinafter referred to as "salary or other wage" in this Part) received by the day on which the person came to fall under either of these cases in that year, the name or corporate name of the payer of that salary or other wage (the payer of the primary salary or other wage, if there are two or more payers; the same applies hereinafter in this item), and the location of its office, place of business or other similar place that handled the payment business for that salary or other wage;

ロthe amount of salary or other wage received from the payer of the salary or other wage in (a), and the amount of income tax collected on that salary or other wage pursuant to Article 183, paragraph (1) (Obligation to Withhold Taxes on Salary Income) of the Act;

四any other matters for reference.

一the name, domicile and individual number of the person who submits the return under Article 194, paragraph (6) of the Act;

二the name of the payer of the salary or other wage prescribed in Article 194, paragraph (1) of the Act through whom the return is to be submitted pursuant to paragraph (6) of that Article;

三any other matters for reference.

一for a relative residing outside Japan listed in Article 316-2, paragraph (2), item (i) or item (ii) of the Order, any of the following documents relating to that relative residing outside Japan that certifies, according to the category of person listed in item (i) or item (ii) of that paragraph, the matter provided for in item (i) or item (ii) of that paragraph (including, where the document is prepared in a foreign language, its translation):

イa copy of a family register supplement or other document issued by the national government or a local government, and a copy of the passport (meaning the passport prescribed in Article 2, item (v) (Definition) of the Immigration Control and Refugee Recognition Act; the same applies in (a) of the following item);

ロa document issued by a foreign government or a local government of a foreign state (limited to one stating the name, date of birth and domicile or residence of the relative residing outside Japan);

二for a relative residing outside Japan listed in Article 316-2, paragraph (2), item (iii) of the Order, any of the following documents relating to that relative residing outside Japan that certifies that the relative residing outside Japan falls under a relative other than the spouse of the Resident prescribed in that paragraph (including, where the document is prepared in a foreign language, its translation) (where the fact that the relative residing outside Japan falls under a relative for Withholding deduction listed in Article 194, paragraph (1), item (vii) (Salary Income Earner's Return for Deduction for Dependents, etc.) of the Act is that the relative falls under the persons listed in Article 2, paragraph (1), item (xxxiv)-2, (b), (1) (Definitions) of the Act, both the document that so certifies and any of the documents listed in the items of Article 47-2, paragraph (9) relating to that relative residing outside Japan, issued by a foreign government or a local government of a foreign state, that certifies that the relative residing outside Japan has ceased to have a domicile or residence in Japan by residing in a foreign state with a status corresponding to the status of residence of "Student" in the table of Appended Table I (4) (Status of Residence) of the Immigration Control and Refugee Recognition Act in that foreign state (including, where that document is prepared in a foreign language, its translation)):

イa copy of a family register supplement or other document issued by the national government or a local government, and a copy of the passport;

ロa document issued by a foreign government or a local government of a foreign state (limited to one stating the name, date of birth and domicile or residence of the relative residing outside Japan).

一a document of a financial institution prescribed in Article 2, item (iii) (Definitions) of the Act on Submission of Statement of Overseas Wire Transfers for Purpose of Securing Proper Domestic Taxation, or a copy thereof, that clarifies that payment was made from the Resident to the relative residing outside Japan through an exchange transaction carried out by that financial institution;

二a document of the credit card, etc. purchase intermediary prescribed in Article 47-2, paragraph (6), item (ii), or a copy thereof, that clarifies that the credit card, etc. purchase intermediary has received, or is to receive, from the Resident an amount of money equivalent to the price of the goods or rights, or the consideration for the services, that is to be paid as a result of the relative residing outside Japan presenting or notifying the credit card, etc. prescribed in that item and purchasing goods or rights from a specific seller, or receiving the provision of services for a fee from the specific service provider prescribed in that item;

三a document of the electronic payment instruments service provider prescribed in Article 47-2, paragraph (6), item (iii), or a copy thereof, that clarifies that payment was made from the Resident to the relative residing outside Japan through a transfer of an electronic payment instrument prescribed in that item carried out by that electronic payment instruments service provider at the request of the Resident (in the case of a document of a deemed electronic payment instruments service provider prescribed in that item, or a copy thereof, limited to one relating to an electronic payment instrument prescribed in that item that is issued by that deemed electronic payment instruments service provider).

一the name, domicile and individual number of the person who submits the return under Article 195, paragraph (1) of the Act (hereinafter referred to as the "filer" in this paragraph);

二the date of birth, domicile and estimated amount of total income of the spouse for Withholding deduction;

三the date of birth, domicile, relationship to the filer and estimated amount of total income of the relative for Withholding deduction;

四the name of the payer of the primary salary or other wage prescribed in Article 194, paragraph (1) (Salary Income Earner's Return for Deduction for Dependents, etc.) of the Act, the estimated amount of revenue from salary or other wage to be paid by that payer during that year, the amount obtained by deducting from that estimated amount the estimated amount of the social insurance premiums prescribed in Article 74, paragraph (2) (Social Insurance Premium Deduction) of the Act and the estimated amount of the small enterprise-based mutual aid premiums and similar payments prescribed in Article 75, paragraph (2) (Deduction for Small Enterprise-based Mutual Aid Premiums and Similar Payments) of the Act that are to be deducted from that salary or other wage, and the total amount of the amounts equivalent to the amount of disability deduction, widow deduction, single parent deduction and working student deduction recognized for the filer, the amount of spousal deduction or special spousal deduction to be claimed for the spouse for Withholding deduction, the amount of deduction for Dependents or special deduction for specified relatives to be claimed for the relative for Withholding deduction, and the amount of basic personal exemption;

五any other matters for reference.

一the name, domicile and individual number of the person who submits the return under Article 195, paragraph (3) of the Act;

二the name of the payer of the secondary salary or other wage prescribed in Article 195, paragraph (1) of the Act through whom the return is to be submitted pursuant to paragraph (3) of that Article;

三any other matters for reference.