Notification of Establishment/Relocation/Closure of a Salary-Paying※ 整 理Office番号
給与支払事務所等の開設・移転・廃止届出書
Establisher of office事務Day月日

年

税務署長殿
所得税法第 230 条の規定により次のとおり届け出ます。

Year

開設・移転・廃止年月日 令 和

Leave the left end blank and start fromhere to enter your individual number.

Individual number or corporate number
Representative’s name

代表者氏名
(注)

Date of establishment, relocation or closure date年

「住所又は本店所在地」欄については、個人の方については申告所得税の納税地、法人につい□Other than the above□ 開業又は法人の設立

開設□Succession to anexisting
Salary-Paying
Office, etc.

開設・異動前開設した支店等の所在地□ 所在地の移転

移転

Relocation(Reason)□ Corporatemerger□Company split□Closing of abranch, etc.
□Other () Closure

廃止

移転後の所在地

Location after relocation

Location before relocation
引 継 ぎ を す る 前 の 引継先の給与支払
給与支払事務所等
事務所等(理由) □ 法人の合併 □ 法人の分割 □ 支店等の閉鎖□ その他□Suspension（） of businessSucceeding Salary-Paying
Office, etc.

Salary-Paying Office, etc.
before succession□ 休業□Closure of business or completion of liquidation
その他（）
OtherLocation of the branch, etc. established

移転前の所在地□Relocation□ 既存の給与支払事務所等への引継ぎ□ 廃業又は清算結了

異動後Before the establishment・change*Establishment of a□ 上記以外
branch, etc. in a place
different from the location※本店所在地等とは別の所在地に支店等を開設した場合
of the head office, etc.

Matters to beentered in “Aboutthe Salary-Paying
Office, etc.” date
After the change「給与支払事務所等について」欄の記載事項（該当する事項のチェック欄□に✓印を付してください。）

Establishment(Notes) In “Addressor location of thehead office,” anindividual must enter
the place of tax
payment for
self-assessed income
tax and a corporationmust enter thelocation of the headoffice. (or location ofthe overseas headoffice in the case of aforeign corporation)ては本店所在地（外国法人の場合には国外の本店所在地）を記載してください。
DayMonthSalary payment
commencementdate
月日 給与支払を開始する年月日 令 和年月日

〇Content of and reason for this Notification○届出の内容及び理由(Check the relevant box.)□Establishmentof a business orcorporation－↓個人番号の記載に当たっては、左端を空欄とし、ここから記載してください。

個人番号又は法 人 番 号（フリガナ）

者

I hereby give notification
as follows under Article
230 of the Income TaxAct.

）

Name

氏名又は名称設

District Director of Tax Office

Address or location of the head officeTel（フリガナ）

開令和Month電話（所Year

Date of submission

Postal code

〒住 所 又 は本 店所 在地

異動前の事項〇About the Salary-Paying Office, etc.

Matters after the change

異動後の事項Matters before the change○給与支払事務所等について

開設・異動前Name
Address orlocation of thehead office（フリガナ）〒〒TelTel電話（Number ofemployees

After the change

氏名又は名称

住所又は所在地

Name ofresponsible
person

異動後

Before the establishment/change）

－

電話（）

－

（フリガナ）

Officers

責任者氏名
従事員数

役員

人

Employees
従業員人 （Other matters for reference

税署

理士

決算
期部門

※税務署
処理欄
03.06 改正

名

番号確認
□□

身元確認済未済）人

（）

人 （）人

計

Certified public tax accountant’s signature業種番号入力

名簿等

確認書類
個人番号カード／通知カード・運転免許証
その他（）

用紙
交付

通 信
日付印

年 月 日 確認人

（ 規 格 Ａ ４ ）(その他参考事項)

Total

Guidelines for Filling in the Notification of Establishment/Relocation/Closure of a Salary-Paying
Office1. This Notification must be submitted within one month from the date of establishment, relocation or closure of anoffice, etc. that handles the payment of salary, etc. (hereinafter referred to as a “Salary-Paying Office, etc.”) to thecompetent district director having jurisdiction over the location of such Salary-Paying Office, etc. (In the case ofrelocation, submit this Notification to the competent district director having jurisdiction over the location of suchoffice before relocation.)
2. Fill in each column as follows:(1) In each column of “Establisher of office,” enter the address (residence) or location of the head office(principal office) (or location of the overseas head office in the case of a foreign corporation), name,individual number or corporate number of the person or corporation submitting this Notification, as well as
the representative’s name if the establisher is a corporation.
(2) In “Salary payment commencement date,” enter the date (or expected date) of commencement of salary
payment if salary payment is not commenced within the month in which the Salary-Paying Office, etc. isestablished.
(3) In “Content of and reason for this Notification,” check the relevant box.
If any change is made to the matters notified such as the name of the Salary-Paying Office, etc., enter thechanged matter in the column “Other” and the content of the change in the column “About the Salary-PayingOffice, etc.”(4) In each column of “About the Salary-Paying Office, etc.,” enter the required matters based on the content ofand reason for this Notification.
(Notes) If the Salary-Paying Office, etc. has been relocated, the tax payment place for withholding income
tax imposed on salaries paid before relocation is deemed to be the location of the Salary-Paying
Office, etc. after relocation that is shown in this Notification.
Therefore, in the case of corporate merger or company split, the tax payment place for withholding
income tax of the merged corporation or split corporation is succeeded to by the location of theSalary-Paying Office, etc. (the head office or branch, etc.) of the merging corporation or succeeding
corporation in a company split.
In addition, the Salary-Paying Office, etc. that is a branch, etc. is not deemed to have been abolishedunless the establisher of the office closes the business or complete liquidation. If such branch, etc.
has been closed, the tax payment place for such branch is succeeded to by the location of another
Salary-Paying Office, etc. (the head office or another branch, etc.).
[Matters to be entered for each reason when a Salary-Paying Office, etc. is succeeded by another existing
Salary-Paying Office, etc.]
Reason for
Salary-Paying Office, etc. before
Succeeding Salary-Paying Office, etc.
succession
succession
Merged corporation (mergedMerging corporation’s head office orCorporate merger corporation’s head office and branches,branches, etc.
etc.)
Split corporation (split corporation’s
Succeeding corporation’s head office
Company split
head office and branches, etc.)
or branches, etc.
The head office or another branch, etc.
Closure of athat succeeds to the salary payment
Branches, etc. to be closedbranch, etc.
operations performed by the branch,etc. to be closed(5) In “Number of employees,” enter the number of employees of each job type who receive salary, etc.
(6) In “Other matters for reference,” enter the name of the person who operated a sole proprietorship that wasclosed due to incorporation, tax payment place and reference number for such enterprise, the principal officein Japan in the case of a foreign corporation. Also, if the overseas head office of a foreign corporation
completed the liquidation, enter to that effect and the date of the completion of the liquidation. Moreover,enter other matters for reference.
(7) If this Notification is prepared by a certified public tax accountant or a tax accountant corporation, suchcertified public tax accountant, etc. is required to place his/her signature in “Certified public tax accountant’ssignature.”(8) Do not fill in the columns marked with ※.
3. Matters to be noted Indication of the name of trust subject to corporation taxation
If a trustee of the trust subject to corporation taxation stipulated in Item 29-2 of Article 2 of the Corporation

Tax Act submits this notification for this trust, such trustee must indicate the name of a trust subject tocorporation taxation together with the corporate name or personal name of trustee in the column “Name” onthis notification.