一the matters specified below in accordance with the category of Withholding receipt set forth below

イa Withholding receipt to be submitted to the competent district director: the name, domicile or residence and individual number of the person receiving the payment of that salary or other wage, and the name or title, domicile or residence or location of the head office or principal office, individual number or corporate number, and telephone number of the person paying that salary or other wage;

ロa Withholding receipt to be delivered to the person receiving the payment of the salary or other wage: the name and domicile or residence of the person receiving the payment of that salary or other wage, and the name or title, domicile or residence or location of the head office or principal office, and telephone number of the person paying that salary or other wage.

二with respect to the salary or other wage the payment of which was finalized during the year (including, where that salary or other wage has been subject to Article 190 (Year-End Adjustment) of the Act and the person receiving the payment has, in that year, submitted, through another payer of salary or other wage, another salary income earner's return for deduction for Dependents, etc. (meaning a salary income earner's return for deduction for Dependents, etc. prescribed in Article 194, paragraph (8) (Salary Income Earner's Return for Deduction for Dependents, etc.) of the Act; the same applies in item (vi) and in item (iii) of the following paragraph), the salary or other wage prescribed in Article 311 (Salary or Other Wage Subject to Year-End Adjustment for Persons Who Have Changed Employment, etc.) of the Order), its type and total amount;

三with respect to the salary or other wage in the preceding item that has been subject to Article 190 of the Act, the amount of salary or other wage after the salary income deduction in Appended Table V of the Act, obtained in accordance with its amount under that table;

四the amount of income tax to be collected on the salary or other wage in item (ii) pursuant to Part IV, Chapter II (Withholding on Salary Income) of the Act;

五the amount of social insurance premiums prescribed in Article 74, paragraph (2) (Social Insurance Premium Deduction) of the Act and the amount of 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, which are deducted from the salary or other wage in item (ii);

六the following matters in accordance with what is stated in a salary income earner's return for deduction for Dependents, etc., a return for deduction for Dependents, etc. regarding secondary salaries (meaning a return for deduction for Dependents, etc. regarding secondary salaries prescribed in Article 195, paragraph (6) (Return for Deduction for Dependents, etc. Regarding Secondary Salaries) of the Act), a salary income earner's return for spousal deduction, etc. (meaning a salary income earner's return for spousal deduction, etc. prescribed in Article 195-2, paragraph (3) (Salary Income Earner's Return for Spousal Deduction, etc.) of the Act) or a salary income earner's return for special deduction for specified relatives (meaning a salary income earner's return for special deduction for specified relatives prescribed in Article 195-3, paragraph (3) (Salary Income Earner's Return for Special Deduction for Specified Relatives) of the Act):

イthe matters specified below in accordance with the category of Withholding receipt set forth below:

（１）a Withholding receipt to be submitted to the competent district director: the following matters:

（ｉ）whether there is a Claimable Spouse (where the salary or other wage has not been subject to Article 190 of the Act, a spouse for Withholding deduction; referred to as a "claimable spouse, etc." in (a)), the name and individual number (for a person who has no individual number, the name; the same applies in (ii)) of the claimable spouse, etc. or the spouse prescribed in Article 83-2, paragraph (1) (Special Spousal Deduction) of the Act whose living expenses are paid from the same resources (referred to as a "spouse eligible for special deduction" in (a) and the following item), and, where the claimable spouse, etc. falls under a Claimable Elderly Spouse or where the claimable spouse, etc. or the spouse eligible for special deduction is a Nonresident, a statement to that effect;

（ｉｉ）the number of Claimable Dependents or specified relatives (meaning the specified relatives prescribed in Article 84-2, paragraph (1) (Special Deduction for Specified Relatives) of the Act; the same applies in item (viii)) (where the salary or other wage has not been subject to Article 190 of the Act, relatives for Withholding deduction; referred to as "claimable dependents, etc." in (a)), the name and individual number of each claimable dependent, etc., and, where a claimable dependent, etc. is a Nonresident, a statement to that effect and the fact that makes the person a claimable dependent, etc.;

（２）a Withholding receipt to be delivered to the person receiving the payment of the salary or other wage: the following matters:

（ｉ）whether there is a claimable spouse, etc., the name of the claimable spouse, etc. or the spouse eligible for special deduction, and, where the claimable spouse, etc. falls under a Claimable Elderly Spouse or where the claimable spouse, etc. or the spouse eligible for special deduction is a Nonresident, a statement to that effect;

（ｉｉ）the number of claimable dependents, etc., the name of each claimable dependent, etc., and, where a claimable dependent, etc. is a Nonresident, a statement to that effect and the fact that makes the person a claimable dependent, etc.;

ロwhere, among the relatives for Withholding deduction, there is a Specified Dependent, an Elderly Dependent falling under Article 41-16, paragraph (1) (Special Provisions on Deduction for Dependents for Cohabiting Elderly Parents, etc.) of the Act on Special Measures Concerning Taxation, or another Elderly Dependent, the number of such persons;

ハwhere, among the spouse in the same household or Dependents, there is a cohabiting Person with a Particular Disability prescribed in Article 85, paragraph (2) (Time of Determination of Dependents and Similar Persons) of the Act, another Person with a Particular Disability, or a Person with a Disability other than a Person with a Particular Disability, the number of such persons;

七with respect to a Resident who has a Claimable Spouse or a spouse eligible for special deduction, the amount corresponding to the amount of spousal deduction or the amount of special spousal deduction calculated as provided in Article 190, item (ii), (d) of the Act, and the amount of total income of that spouse eligible for special deduction prescribed in Article 190, item (ii), (d) of the Act, or the estimated amount thereof;

八with respect to a Resident who has a specified relative, the amount corresponding to the amount of special deduction for specified relatives calculated as provided in Article 190, item (ii), (e) of the Act and the total amount thereof, and the amount of total income of that specified relative prescribed in Article 190, item (ii), (e) of the Act, or the estimated amount thereof;

九the amount that would be deducted if Articles 74 through 77 (Social Insurance Premium Deduction, etc.) of the Act were applied to the amount of social insurance premiums prescribed in Article 190, item (ii), (b) of the Act, the amount of small enterprise-based mutual aid premiums and similar payments, the amount of new life insurance premiums, the amount of old life insurance premiums, the amount of nursing care and medical insurance premiums, the amount of new individual annuity insurance premiums, the amount of old individual annuity insurance premiums, and the amount of earthquake insurance premiums;

十where the person receiving the payment of the salary or other wage in item (ii) falls under a Person with a Particular Disability or another Person with a Disability, a widow, a single parent, or a working student, a statement to that effect.

十一the amount of the special income tax credit where a person has housing loans, etc. in year-end adjustment pursuant to Article 41-2-2, paragraph (1) (Special Income Tax Credit Where a Person Has Housing Loans, etc. in Year-End Adjustment) of the Act on Special Measures Concerning Taxation;

十二where Article 41-3-8, paragraph (1) (Deduction, etc. of the Amount of Special Deduction in Year-End Adjustment in 2024) of the Act on Special Measures Concerning Taxation applies, the year-end adjustment special deduction amount prescribed in Article 41-3-8, paragraph (2) of that Act, and the amount (zero if there is no such amount) by which 30,000 yen forming the basis for calculating that year-end adjustment special deduction amount (where there is a person set forth in the items of that paragraph, the amount obtained by adding 30,000 yen for each such person to 30,000 yen) exceeds the amount of tax prescribed in that paragraph, and, where there is a person set forth in item (iii) of that paragraph (excluding a Claimable Spouse prescribed in item (i) of that paragraph) relating to that year-end adjustment special deduction amount, a statement to that effect;

十三any other matters for reference.

一where the amount of payment during the year to the same person of salary or other wage that has been subject to Article 190 of the Act (excluding salary or other wage paid to a person prescribed in Article 204, paragraph (1), item (ii) (Obligation to Withhold Taxes on Remuneration, Fees, etc.) of the Act and salary or other wage prescribed in the following item) is 5,000,000 yen or less;

二where the amount of payment during the year to the same person of salary or other wage that has been subject to Article 190 of the Act and that a corporation pays to its officer (including a counselor, advisor and other persons similar to them) is 1,500,000 yen or less;

三where the amount of payment during the year to the same person of salary or other wage, other than that prescribed in the preceding two items, which is paid to a person who has submitted a salary income earner's return for deduction for Dependents, etc. (excluding an officer set forth in the preceding item) by the payer of salary or other wage through whom the return was submitted at that time, is 2,500,000 yen or less;

四where the amount of payment during the year to the same person of salary or other wage other than that prescribed in the preceding three items is 500,000 yen or less.

一the name and domicile or residence, or the name, location of the head office or principal office, and corporate number, of the person submitting the written application;

二a statement that the person seeks to obtain that approval, and the reason therefor;

三any other matters for reference.

一the matters specified below in accordance with the category of Withholding receipt set forth below:

イa Withholding receipt to be submitted to the competent district director: the name, domicile or residence and individual number of the person receiving the payment of that severance pay or other such compensation, and the name or title, domicile or residence or location of the head office or principal office, individual number or corporate number, and telephone number of the person paying that severance pay or other such compensation;

ロa Withholding receipt to be delivered to the person receiving the payment of the severance pay or other such compensation: the name and domicile or residence of the person receiving the payment of that severance pay or other such compensation, and the name or title, domicile or residence or location of the head office or principal office, and telephone number of the person paying that severance pay or other such compensation;

二the amount of severance pay or other such compensation the payment of which was finalized during the year, and the category of that severance pay or other such compensation to which Article 201, paragraph (1), item (i) or (ii) or paragraph (3) (Amount of Taxes Withheld) of the Act applies;

三the amount of income tax to be collected on the severance pay or other such compensation in the preceding item, for each category in that item, pursuant to Part IV, Chapter III (Withholding on Retirement Income) of the Act;

四the period of service equivalent to the years of service prescribed in Article 201, paragraph (2) of the Act, and the details of its calculation;

五where the case set forth in Article 30, paragraph (6), item (i) (Retirement Income) of the Act applies, the basis for calculating the retirement income deduction prescribed in Article 201, paragraph (2) of the Act;

六any other matters for reference.