国内において給与等の支払を受ける居住者は、第百九十条（年末調整）に規定する過不足の額の計算上、同条第二号ヘに掲げる基礎控除の額に相当する金額の控除を受けようとする場合には、その給与等の支払者（二以上の給与等の支払者から給与等の支払を受ける場合には、主たる給与等の支払者）からその年最後に給与等の支払を受ける日の前日までに、次に掲げる事項を記載した申告書を、当該給与等の支払者を経由して、その給与等に係る所得税の第十七条（源泉徴収に係る所得税の納税地）の規定による納税地の所轄税務署長に提出しなければならない。
If a Resident paid a salary or other wage in Japan seeks to receive a deduction of the amount equivalent to the basic personal exemption set forth in item (ii), (f) of Article 190 (Year-End Adjustment) in calculating the amount of the excess or shortfall prescribed in that Article, the Resident must submit a declaration stating the following particulars to the competent district director for the locality for paying over taxes under Article 17 (Locality for Paying Over Withholding Tax) for the income taxes on that salary or other wage, via the person paying that salary or other wage (or, if the Resident is paid salaries or other wages by two or more persons paying a salary or other wage, the principal payer of salary), by the day before the day on which the Resident is paid the last salary or other wage for the year by that payer:
当該給与等の支払者の氏名又は名称
the name of that person paying the salary or other wage;
その他財務省令で定める事項
any other particulars specified by Ministry of Finance Order.
前項の規定による申告書は、給与所得者の基礎控除申告書という。
A declaration under the preceding paragraph is referred to as a salary income earner's return for basic personal exemption.