JAPAN

TAX REFUND

Instructions
taxback.com
E: info@taxback.com
W: www.taxback.com
Skype: AskTaxBack

This package contains a number of forms which will make getting your tax refund with taxback.com fast and stress-free.
All you need to do is print the forms and follow the instructions below on how to complete them.
Page 2 Registration Form this is the only form that needs to be fully completed in English. Any additional
information (more than 2 employments per calendar year) to be written on a separate page or at the back of the
registration page.
Page 3 The Letter of Request should be signed and dated.

US Head Office:
333N. Michigan Ave.
Suite 2415
Chicago, IL 60601
USA
P: 001 888 203 8900
F: 001 312 873 4202
European Address:
IDA Business & Technology Park
Ring Road, Kilkenny, Ireland
P: 0353 1 887 1999
F: 0353 1 670 6963

Page 4 Customer Agreement should be signed, dated and named.

Page 5 The Power of Attorney form in Japanese should be signed and dated in the top right corner, as shown.
Pages 6, 7 and 8 should be signed and dated in the top right corner, as shown.
Page 9 should be signed only.
All forms together are the Japanese income tax refund pack.
All forms should be printed using black and white scale and A4 format on absolutely blank sheets. All signatures
have to be the same as the signature on all your official documents. The forms in the pack should not be stapled,
stamped or glued.
Also in order to speed up the application process we require copies of the following documents, but only if they
are available:
A photocopy of your passport (the pages showing your name, date of birth, nationality, the stamp showing
departure from Japan, or the stamp showing your re-entry into your home country and your signature).
Your Gensen-Choshu-Hyo (Statement of Income) from each of your employers. If you have lost these documents,
we can obtain replacements for you.
Completed packs must contain all the forms as described here.
As soon as we receive all forms our team will contact you with information.
Looking forward to receiving your forms shortly!

Thank you for your cooperation:

taxback.com

Visit www.taxback.com for further details about our services

japan@taxback.com

JAPAN

TAX REFUND

APPLICATION FORM
1
1

Sign the
forms

PERSONAL INFORMATION
PLEASE PRINT IN BLOCK CAPITALS

Send with
your tax info
2

EMPLOYMENT INFORMATION

Employer 1
Note: if you worked for an agency, please provide the full
contact details of your employer, from whom you received wages.

First Name:

Nitai

Company name:

Surname:

Karmakar

Address:

Middle Initial:

Title: Mr

Mrs

Receive your
refund

City & Code:

Telephone:

Telephone:

Fax:

Mobile:

Company email:

Email Address:

Website:

Date of Birth:

DAY MONTH YEAR

Date started work:

DAY MONTH YEAR

Todays Date:

DAY MONTH YEAR

Date finished work:

DAY MONTH YEAR

Do you have a Gensen-Chosho-Hyo/ Final

Payment Slip for this job?
Yes

Subject / Occupation:

US Head Office:
333N. Michigan Ave.
Suite 2415
Chicago, IL 60601
USA
P: 001 888 203 8900
F: 001 312 873 4202
European Address:
IDA Business & Technology Park
Ring Road, Kilkenny, Ireland
P: 0353 1 887 1999
F: 0353 1 670 6963

Miss

Home Country Address:

taxback.com
E: info@taxback.com
W: www.taxback.com
Skype: AskTaxBack

No

How did you hear about our company?

3
Date of arrival
in Japan:

DAY MONTH YEAR

Date of departure
from Japan:

DAY MONTH YEAR

EMPLOYMENT INFORMATION

Employer 2
Note: if you worked for an agency, please provide the full
contact details of your employer, from whom you received wages.

Company name:
Address:

Visa Type and Programme:

Have you filed a tax return for any financial years to the tax
office in Japan? No
If yes, please give details:
Year:_________ Refund mount: JPY____________
Have you received your pension back? Yes

No

Have you received the 20% tax on the pension refund

back? Yes No
Pension Number: ____________________________
Do you have your pension book? Yes

No

Your residing address in Japan:

City & Code:

Telephone:
Fax:
Company email:
Website:
Date started work:

DAY MONTH YEAR

Date finished work:

DAY MONTH YEAR

Do you have a Gensen-Chosho-Hyo/ Final

Payment Slip for this job?
Yes

No

Have you paid your local/ residence taxes before

leaving Japan? Yes No
Visit www.taxback.com for further details about our services
The more information you can provide the quicker you will receive your refund

japan@taxback.com

LETTER OF REQUEST
Nitai Karmakar
I, the undersigned ________________________________________,
residing at:
_______________________________
_______________________________
_______________________________

Worked for ______________________ from _______________ to _______________. My

employee number was __________________.
In order to file my Japanese income tax return for the year(s)______________________ I
would like to request the original of my gensen-chosyu-hyo for the year(s)____________.
I would appreciate if you send the gensen- chosyu- hyo to the following address:

TAXBACK.COM
105-6027 Tokyo
Minato-ku, Toranomon 4-3-1,
Shiroyama Trust Tower, Level 27
Japan
Signed: X ______________________

Date:

_____________________

JAPAN

TAX REFUND

CUSTOMER AGREEMENT
taxback.com
E: info@taxback.com
W: www.taxback.com
Skype: AskTaxBack

I confirm that
1.

I understand that taxback.com is a trading name for the services of Taxback Inc., Chicago, USA, and its parent
company Taxback, Ireland and its subsidiaries and representative companies.

2.

I have not filed an income tax return/applied for an income tax refund from Japan for this tax year or
authorized any other party to do so on my behalf.

3.

I have signed the necessary power of attorneys to authorize Taxback Inc., trading as
taxback.com, and owned by Taxback, and referred to hereafter as the
Agent, to prepare this tax return and represent me before the Japanese Tax Authorities.

4.

I authorize the Agent to receive all correspondence from the Japanese Tax Authorities on my behalf.

5.

I want to avail of the offer to pay no fee up-front when I sign up for the service.

6.

I authorize the Agent to receive my refund cheque(s) from the tax authorities.

7.

I further authorize the Agent to endorse the cheques, deduct the necessary fee and to send
me the remaining amount.

8.

Should I receive the refund directly from any other source other than the Agent, I understand and agree that
I will pay the fee due to taxback.com for the work completed.

9.

Should I owe income tax for other tax years, and the Japanese Tax Authorities deduct this owed money from
the refund due for other tax year (s), I understand and agree that I need to pay the Agent a processing
fee for each tax year for which a tax return was processed.

US Head Office:
333N. Michigan Ave.
Suite 2415
Chicago, IL 60601
USA
P: 001 888 203 8900
F: 001 312 873 4202
European Address:
IDA Business & Technology Park
Ring Road, Kilkenny, Ireland
P: 0353 1 887 1999
F: 0353 1 670 6963

10. I understand that the Japanese Tax Authorities will make the final decision on the value of any refund due.

I understand that taxback.com will provide the best estimation possible based on current tax law and

information given, however this is an estimation only, not a guarantee.
11.

I agree to and accept the terms and conditions of service as written online at www.taxback.com and to any
changes in the terms and conditions which Taxback Inc may effect from time to time, and to the fees of the
agent which represents the services which I have requested and which are to be provided by Taxback Inc
and/or its affiliate companies.

12. I confirm that I have given taxback.com all information needed and available to me.
13. I commit to updating taxback.com of any change in my contact details.

Name in print:

X Nitai Karmakar
____________________________

Signature :

____________________________ Date:_________/__________/_________

Visit www.taxback.com for further details about our services

japan@taxback.com

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Social Insurance Operation Center

Takaido Nishi 3-5-24
Suginami-ku
Tokyo 168-8505
Japan

To Whom It May Concern:

My name is ___________________________ I had been working in Japan from
_____________to _____________for________________.
I contributed to the Japanese Pension System. When I left Japan, I applied for my pension
refund, which I received in __________________. As 20% income tax was deducted from
my pension refund, I would like to file a tax return to receive this money. Unfortunately, I no
longer have my Notice of the Lump-sum Withdrawal Payment (Remittance), which is
necessary in order to receive a tax refund.
My basic pension number was ___________________.
I would appreciate if you could send me a copy of my Notice of the Lump-sum Withdrawal
Payment (Remittance) to the following address:
TAXBACK.COM
105- 6027 Tokyo
Minato- ku Toranomon 4-3-1
Shiroyama Trust Tower, Level 27

Best Regards,

X_______________________