A request for review must, pursuant to the provisions of Cabinet Order, be filed by submitting a document stating the following matters:
審査請求は、政令で定めるところにより、次に掲げる事項を記載した書面を提出してしなければならない。
the details of the disposition to which the request for review pertains;
審査請求に係る処分の内容
the date on which the person became aware that the disposition to which the request for review pertains had been made (or, if the person received a notice concerning the disposition, the date on which the person received the notice, and, if the request for review is filed concerning the disposition as it stands after a determination on a request for reinvestigation, the date on which the person was served with a certified copy of the written determination on reinvestigation);
審査請求に係る処分があつたことを知つた年月日（当該処分に係る通知を受けた場合にはその通知を受けた年月日とし、再調査の請求についての決定を経た後の処分について審査請求をする場合には再調査決定書の謄本の送達を受けた年月日とする。）
the object of and reasons for the request for review;
審査請求の趣旨及び理由
the date of the request for review.
審査請求の年月日
In addition to the matters prescribed in the preceding paragraph, the document referred to in that paragraph (hereinafter referred to as a "written request for review" in this Subsection) must, in the cases listed in the following items, state the matters specified in those items:
if a request for review is filed without going through a determination on a request for reinvestigation under Article 75, paragraph (4), item (i) (Appeals against Dispositions Concerning National Tax): the date on which the request for reinvestigation was filed;
第七十五条第四項第一号（国税に関する処分についての不服申立て）の規定により再調査の請求についての決定を経ないで審査請求をする場合 再調査の請求をした年月日
if a request for review is filed without going through a determination on a request for reinvestigation under Article 75, paragraph (4), item (ii): the justifiable reason prescribed in that item;
第七十五条第四項第二号の規定により再調査の請求についての決定を経ないで審査請求をする場合 同号に規定する正当な理由
if a request for review is filed after the expiry of the period prescribed in Article 77, paragraphs (1) through (3) (Period for Filing Appeals): the justifiable reason prescribed in the proviso to the relevant paragraph.
第七十七条第一項から第三項まで（不服申立期間）に規定する期間の経過後において審査請求をする場合 これらの各項のただし書に規定する正当な理由
The object prescribed in paragraph (1), item (iii) is to be stated so as to make clear the extent to which revocation or change of the disposition is sought, and the reasons prescribed in that item are to make clear the assertions of the requester for review against the reasons for the disposition of which the requester was notified by a written notice or other document concerning the disposition.