公表の同意を撤回する旨の届出書◎Notification to Revoke the Consent to the Publication（こ受 付 印
※ 太枠は必ず記載してください。
提の出届の 出 Date of submission
Corporate Number
法人番号*Make sure to fill in inside the bold frames.
際書
はは（フリガナ）、、
年月日
裏基MonthDay
面 本 Yearの３
Trade name or name
記情商 号 又 は 名 称
載報
要を領公
Postal code
等表（フリガナ）をし（〒－）
ごてAddress of the head office or principal place of business
確い認るIn Japan
く 「 Commissioner of the 本 店 又 は 主 た る□ 国内だ 人 National Tax Agency 事 務 所 の 所 在 地
さ格Outside Japanいの□
国外国税庁長官殿。
）な※ 「国外」にレ印を付した
Tel
場合は日本国外にある本店
い又は主たる事務所の所在地*If the box "Outside Japan"
社（電話番号－－）
を記載
is checked, describe the団
Postalcode
address of the head office or （ フ リ ガ ナ ）等
principal place of business」（〒－）
outside Japan.の代表
Address of the office or business office in Japan
国内における事務所者
又は
営
業
所の所在地
又は
*Describe if "Outside Japan" is checked in the above.
Tel
管※ 上欄で「国外」にレ印を理付した場合に記載（電話番号－－）人の方が、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いて行った、公公表の同意を撤回します。
表I revoke my consent to the publication in accordance with the provisions of the Act on theのUse of Numbers to Identify a Specific Individual in the Administrative Procedure.
同（フリガナ）
意を撤Name of representative
回or administrator
代 表 者 又 は 管 理 人 氏 名すると*The name of the representative or administrator in Japan ifきthere is no head office or principal place of business in Japan※ 国内に本店又は主たる事務所を有しない場合は、国内ににおける代表者又は管理人氏名
使用す
参考事
項
Matters for reference
るものです 整 This
notification
is used when the representativeor回 付日審
査 administrator of an "associations or the like without juridical。 理 personality," whose Basic 3 Information is published, revokes the publication. (See backfor the guidelines for describing
備 page考submitting it.)欄 when
入力処理日

注意

整理欄は記載しないでください。

確認Guidelines for Describing the Notification to Revoke
the Consent to the Publication
1. About the “Notification to Revoke the Consent to the Publication”
This notification is used when the representative or administrator of an association or the like without juridical personality
which was designated a Corporate Number revokes the consent to the publication of the i) trade name or name, ii) addressof the head office or principal place of business and iii) Corporate Number (hereinafter referred to as “the Basic 3Information”), in accordance with the provisions of the Act on the Use of Numbers to Identify a Specific Individual in theAdministrative 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 notification.
(2) In “Trade name or name,” describe the trade name or name of the association or the like without juridical personality
submitting this notification.
(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 notification, 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 orbusiness office in Japan if there is no head office or principal place of business in Japan (i.e. the box “Outside Japan” ischecked 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),the representative 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
When the representative or administrator of an association or the like without juridical personality revokes the consent tothe publication, the Basic 3 Information of the said association or the like without juridical personality will be stopped being
published on the National Tax Agency’s Corporate Number Publication Site (Japanese version).
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
two functions 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”
is submitted 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 theAdministrative Procedure, the heads of administrative organs or the like can request the Commissioner of the National Tax
Agency to provide the Basic 3 Information. Therefore, there are some cases where the Basic 3 Information is provided tothe heads of administrative 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.