法人番号等の公表同意書◎◎記Consent Form to the Publication of the Corporate Number or the like
基載こ受 付 印※ 太枠は必ず記載してください。
本の３要同
情 領 意 Date of submission*Make sure to fill in inside theCorporate Number
法人番号報等書
bold frames.のをは（ フ リ ガ ナ ）
公ご、
年月日
表確基
本 Year Monthに認Day
同く３
Trade name or name
意だ情商 号 又 は 名 称
さ報しいのない。
）公表場（ フ リ ガ ナ ）に合Postal code
同Address of the head office or principal place of business
、
（〒－）
意提す
出る Commissioner of the 本 店 又 は 主 た るIn Japanす「 National Tax Agencyる□ 国内事 務 所 の 所 在 地人
必格
要Outside Japan
国税庁長官殿のは□ 国外
なあ※ 「国外」にレ印を付したいりTel場合は日本国外にある本店
社
ま又は主たる事務所の所在地（電話番号－－）*If the box "Outside Japan"
団
せを記載
ischecked,describe
the等ん
address of the head office or （ フ リ ガ ナ ）」。
Postal code
principal place of businessの（〒－）outside Japan.
代表
国内における事務所者
Address of the office or business office in Japan
又又は営業所の所在地
は管 *Describe if "Outside Japan" is checked in the above.
理Tel人※ 上欄で「国外」にレ印をの（電話番号－－）付した場合に記載
方が使行政手続における特定の個人を識別するための番号の利用等に関する法律の規定に基づき、用商号又は名称、本店又は主たる事務所の所在地及び法人番号を公表することについて、する同意します。
In accordance with the provisions of the Act on the Use of Numbers to Identify a Specific Individual
もin the Administrative Procedure, I consent to the publication of the trade name or name, head officeのor principal place of business and Corporate Number.
で Name of representative（フリガナ）
す or administrator。
（代 表 者 又 は 管 理 人 氏 名提*The name of the representative or administrator in出Japan if there is no head office or principal place ofのbusiness in Japan
際※ 国内に本店又は主たる事務所を有しない場合は、国内
はにおける代表者又は管理人氏名、
裏面
Matters for reference
参考事
項の・ This consent form is used by the representative or administrator of an "association or the like without juridical personality"
who consents
回 付 日to the publication of the Basic 3 Information.
審査(See back page for the guidelines for describing or the like when整submittingit.)
理
備考・ 欄If you
do not consent to the publication of the Basic
you do not need to submit it.
入力処理日
確 3 Information,
認注意

整理欄は記載しないでください。

Guidelines for Describing the Consent Form to the Publicationof the Corporate Number or the like
1. About the “Consent Form to the Publication of the Corporate Number or the like”
This consent form is used when the representative or administrator of an association or the like without juridical personality,
which has been designated a Corporate Number, consents to the publication of the i) trade name or name, ii) address of thehead office or principal place of business and iii) Corporate Number (hereinafter referred to as “the Basic 3 Information”), inaccordance with the provisions of the Act on the Use of Numbers to Identify a Specific Individual in the Administrative
Procedure. Please submit it to the Commissioner of the National Tax Agency
2. How to fill in(1) In “Corporate number,” describe the Corporate Number (13 digits) of the association or the like without juridical
personality submitting this consent form.
(2) In “Trade name or name,” describe the trade name or name of the association or the like without juridical personality
submitting this consent form.
(3) In “Address of the head office or principal place of business,” check the box of either “In Japan” or “Outside Japan”regarding the address of the head office or principal place of business of the association or the like without juridical
personality submitting this consent form, and describe the said address and telephone number.
(4) In “Address of the office or business office in Japan,” describe the address and telephone number of the office or businessoffice in Japan if there is no head office or principal place of business in Japan (i.e. the box “Outside Japan” is checked in(3) above).
If there is more than one office or business office in Japan, describe the address and telephone number of the principal
one.
(5) In “Name of representative or administrator,” the representative or administrator of the association or the like without
juridical personality describes his/her name.
If there is no head office or principal place of business in Japan (i.e. the box “Outside Japan” is checked in (3) above), therepresentative or administrator of the office or business office mentioned in (4) above describes his/her name.
(6) In “Matters for reference,” describe if there is any other matter or the like for reference.
3. Matters to be noted
The Basic 3 Information will be published through the Internet (“The National Tax Agency's Corporate Number PublicationSite” (Japanese version)) if the representative or administrator of the association or the like without juridical personality
consents to the publication.
In addition, the trade name or name to be published will include furigana (Japanese pronunciation).
Furthermore, if the trade name or address is changed after the consent to the publication is granted, the publishedinformation will be revised and the revision history will also be published.
Read the followings carefully regarding the consent to the publication of the Basic 3 Information and the revocation of theconsent:- The National Tax Agency's Corporate Number Publication Site (Japanese version) offers a function to download eachcorporation’s information, as well as a function to search and browse it. The Basic 3 Information provided through these twofunctions is renewed in different timings. (i.e. the search and browse function is renewed from time to time, while thedownload function is renewed periodically). Consequently, if the “Notification to Revoke the Consent to the Publication” issubmitted and the Basic 3 Information can no longer be browsed, the Basic 3 Information will temporarily remain in thedata for downloading until the next renewal.
- It is virtually impossible to completely block the distribution of the published information once it is published, even if the“Notification to Revoke the Consent to the Publication” is submitted and the publication is stopped. This is because theBasic 3 Information is widely used by the general public after being published on the National Tax Agency's Corporate
Number Publication Site (Japanese version).
- In accordance with the provisions of the Act on the Use of Numbers to Identify a Specific Individual in the AdministrativeProcedure, the heads of administrative organs or the like can request the Commissioner of the National Tax Agency toprovide the Basic 3 Information. Therefore, there are some cases where the Basic 3 Information is provided to the heads ofadministrative organs without consent from corporations.
Note that each administrative organ carefully handles the provided information on which a confidentiality obligation isimposed.
* Submit this document to the Office of Corporate Number Management, the Planning Division, the Commissioner’s
Secretariat of the National Tax Agency.