When changing name or address
‘ Who submits
Nonresident individuals, etc., that have changed their name or address
‘ Document to submit
Application Form for Amendment
‘ When to submit
If there is a change in the name or address of the applicant after submitting the Application Form for Withholding Tax Exemption (including special case documents), at least one day preceding the date of the first interest payment after the change has been effected
‘ Submission deadline
By the day before the first interest payment after the amendment
‘ Where to submit
A qualified foreign intermediary or specified book-entry transfer institution, etc.
‘ Verification documents
The following documents must be presented on submission
Documents published or issued by government offices, or other documents similar thereto
* 1 These documents are limited to those created no more than six months before the date of presentation, and those that state the name, etc., and address, etc., of the nonresident individual, etc.
* 2 If the applicant is the trustee of a qualified foreign securities investment trust without corporate status, the prospectus of the entrusted qualified foreign securities investment trust or any other document similar thereto must be attached, in addition to these documents.
‘ Form Completion Guide
E Sections to be completed by nonresident individuals, etc.
A Name of tax office with jurisdiction over specified book-entry transfer institution, etc.
B Address of nonresident individual, etc. (after amendment)
C The name of nonresident individual, etc. (after amendment)
D Address, etc., before amendment
D' Address, etc., after amendment
E Name before amendment
E' Name after amendment
F Name of specified book-entry transfer institution, etc., or qualified foreign intermediary
G Submission date of Application Form for Withholding Tax Exemption
E Sections to be completed by qualified foreign intermediaries, etc.
A Signature of qualified foreign intermediary and date of receipt
B Name of ID document used by qualified foreign intermediary to identify applicant
C Date of receipt by specified book-entry transfer institution, etc.
* 1 When prepared as special case documents, A, B and C may be left blank.
* 2 Headings may be supplemented, deleted, circled, checked or indicated in other ways as appropriate according to the purpose of use
* This form was created by the Japan Securities Dealers Association.
* These examples of completed forms are merely meant as illustrations. Please consult your financial institution for full details on how to complete the form.