法人番号の指定を受けるための届出書に関する変更の届出書
Notification of Change regarding the Notification to be Designated a Corporate Number◎（「受 付 印※ 太枠は必ず記載してください。
提法こ出人のCorporate Number
法人番号*Make sure to fill in inside the bold frames.の 番 届 Date of submission
際号出（フリガナ）
はの書
年月日
Trade name or name、指は商 号 又 は 名 称
裏 定 、 Year MonthDay
面を「設（フリガナ） Address of the head office or principal place of businessの受記け立（〒－）of the載 る 登 Commissioner
Postal code
本 店 又 は 主 た る
National Tax Agency
記要たIn Japan事 務 所 の 所 在 地 □ 国内
法領め
Tel
等 の 人 国 税 庁 長 官 殿 ※ 「国外」にレ印を付した場 □ 国外
Outside Japanを届以合は日本国外にある本店又は（電話番号－－）
ご 出 外*If the box "Outside Japan" 主たる事務所の所在地を記載の確 書 is checked, describe the （ フ リ ガ ナ ）Postal code
認 兼 法address of the head office人
く 法 or principal place of（〒－）
国内における事務所だ 人 （business outside Japan.
Address of the office or business office in Japan
又は営業所の所在地
さ番国のTelい号機※ 上欄で「国外」にレ印を付。
（電話番号－－）
した場合に記載）等関の 、 *Describe if "Outside
公 地 Japan" is checked in （ フ リ ガ ナ ）*The name of the representative or administrator in Japan
表 方 the above.
if there is no head office or principal place of business in
同公
代表者又は管理人氏名
Japan意共of representative
書 団 Name※ 国内に本店又は主たる事務or administrator」体
所を有しない場合は、国内に We notify you that the descriptions in the notification to be designated a
おける代表者又は管理人氏名 Corporate Number have been changed as below, in accordance with theをはprovisions of the Act on the Use of Numbers to Identify a Specific Individual in
提除
the Administrative Procedure.
出くし）
法人番号の指定を受けるための届出書に記載した事項に変更があったので、行政手続におけるた」
法 又 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、次のとおり届け出ます。
人は□Trade name or name
等「□Address of the head office or principal place of businessの人□Address of the office or business office in Japan代格□ 商号又は名称□Completion of liquidation or the like
表の者 な Changed matter□ 本店又は主たる事務所の変 更 前 の又いNotified matter before the change
所在地
届 出 事 項は 社 変更があった事項
管団□ 国内における事務所又は理等営業所の所在地
人」
での□ 清算の結了等
方Date of the change
がNotified matter after the change
変 更 後 の年月日
使届 出 事 項変 更 が あ っ た
用MonthYearDayす年月日□A copy of the articles of incorporation, the articles of endowment,る
the rules or regulations, or the equivalents (attach the Japanesetranslation if written in other languages than Japanese)
も□If a license or authorization or the like issued by a national organ orのAttached document□ 変更後の定款、寄附行為、規則若しくは規約又はこれらに準ずるものの写し
local public entity is required for the establishment, a copy of theで（日本語以外の言語で記載している場合は和訳文を添付）
document that proves the said license or authorization or the likeす添付書類。
□

変更に当たり法令の規定により国の機関又は地方公共団体の機関の許認可等を必要とする法人は、当該許認可等を証する書類の写し

This整notification
is used by the representative orof a "corporation other than registered corporations for incorporation
回 付 日
審 administrator
査(excluding
national government organs and local public entities)" or an "association
理
備考 or the like without juridical personality," which
欄
入力処理日
確
認Number and the Consent Form to the Publication of the Corporate Number orsubmitted
the "Notification to be Designated a Corporate
the注意like."整理欄は記載しないでください。
(See back page for the guidelines for describing when submitting it.)

Guidelines for Describing the Notification of Change regarding
the Notification to be Designated a Corporate Number
1. About the “Notification of Change regarding the Notification to be Designated a Corporate Number”
This notification is used when there is any change in the descriptions of the “Notification to be Designated a CorporateNumber” (including when there is any change in the descriptions of this notification) in accordance with the provisions ofthe Act on the Use of Numbers to Identify a Specific Individual in the Administrative Procedure. Please submit it, together
with the document specified in the “Attached Document,” 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 corporation or the like submitting thisnotification.
(2) In “Trade name or name,” describe the trade name or name of the corporation or the like 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 corporation or the like submitting thisnotification, 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 corporation or the like 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 “Changed matter,” check the relevant box and describe the change specifically in each “Notified matter before thechange” and “Notified matter after the change.” If the box “Completion of liquidation or the like” is checked, nodescription is required in “Notified matter before the change” and “Notified matter after the change.”Note that "Completion of liquidation or the like" means the completion of liquidation, dissolution due to merger, orothers equivalent to these.
(7) In “Date of the change,” describe the date the change was made regarding (6) above.
(8) In “Attached document,” check the box of document attached to this notification.
3. Matter to be noted
If the consent to the publication of the i) trade name or name, ii) address of the head office or principal place of businessand iii) Corporate Number has already been granted and these information is published on the National Tax Agency'sCorporate Number Publication Site (Japanese version) at the time this notification is submitted, the information after thechange will be published upon submission of the said notification.
* Submit this document to the Office of Corporate Number Management, the Planning Division, the Commissioner’s
Secretariat of the National Tax Agency.