Article 70Matters to Be Entered in a Return Form for a Refund Due to Alternative Taxation on Retirement Income

一the name and domicile of the person who submits the return under Article 173, paragraph (1) of the Act and, if the person has a residence in Japan, that residence (for a person who has an individual number, the name, the domicile and, if the person has a residence in Japan, that residence, and the individual number);

二the basis for calculating the amount of the portion of the total amount of severance pay or other such compensation listed in Article 173, paragraph (1), item (i) of the Act that falls under Article 161, paragraph (1), item (xii), (c) (Domestic Source Income) of the Act;

三the name and location of the bank or post office (meaning an office of Japan Post Co., Ltd. that carries out the postal counter services prescribed in Article 2 (Definitions) of the Post Office Branch Act (Act No. 213 of 1949) and that has the postal savings bank prescribed in Article 94 (Definitions) of the Postal Service Privatization Act (Act No. 97 of 2005) as its affiliated bank prescribed in Article 2, paragraph (16) (Definitions) of the Banking Act (Act No. 59 of 1981) and carries out the business of bank agency prescribed in paragraph (14) of that Article) through which the person wishes to receive the payment of a refund under Article 173, paragraph (2) of the Act;

四any other matters for reference.