Please check that the following items apply.
I am not a Japanese citizen.
I don't have address in Japan.
I have a Pension Handbook.
I worked in Japan for more than half a year and paid the pension insurance premium.
It has not been more than two years since I left Japan.
I understand that there are cases where it is not possible to receive the Lump-Sum Withdrawal Payment for reasons such as the fact that the employer's company has not paid the pension insurance premium.
I appoint Asahi Business Solution Co., Ltd. as my proxy in the following procedures. I agree that the information I give is used for the following procedures.
1. Making a claim for the Lump-Sum Withdrawal Payment
2. Application for the refund of tax deducted from the Lump-Sum Withdrawal Payment
* Formal letter of proxy is required.
* Tax paperwork is entrusted to Asahi Tax Accountant Corporation.
Agreement on commission fee and remittance charge regarding Tax Representative(Agent)
I hereby authorize Asahi Business Solution Co., Ltd., hereinafter referred to as "the Agent", to act as my proxy to make a claim for the Lump-Sum Withdrawal Payment to the Japan Pension Service and to file the tax return which is imposed on my Lump-Sum Withdrawal Payment (Pension Refund) to the tax office which has jurisdiction over my residence in Japan.
1. I appoint the Agent as my Tax Representative, Nouzei Kanrinin [Person to Administer the Taxpayer's Tax Affairs].
2. I understand that I am responsible for sending to the Agent the Dattai Ichijikin Shikyu Kettei Tsuchisho [Notice of Remittance: the Lump-Sum Withdrawal Payment] that I will receive from the Japan Pension Service after the successful processing of my claim for the Lump-Sum Withdrawal Payment (Pension Refund).
3. I understand that it is my responsibility to ensure that the Dattai Ichijikin Shikyu Kettei Tsuchisho reaches the Agent. I acknowledge that the Agent is in no way responsible as my Tax Representative should the Dattai Ichijikin Shikyu Kettei Tsuchisho not reach the Agent.
4. I authorize the Agent to deduct the commission fee and the remittance charge, prearranged in this agreement, from the refunded amount depending on the amount of refund. I also authorize the Agent to deduct from the refunded amount the remittance charge caused by false or incomplete bank information that I submit. I understand that the remaining amount will be sent to my bank account. I understand that the Agent is not liable for failures in bank transmission caused by false or incomplete bank information.
| The Lump-Sum Withdrawal Payment | Business agency commission |
| Less than 100,000 yen | 5,000 yen |
| 100,000 yen ～ 200,000 yen | 15,000 yen |
| 200,001 yen ～ 300,000 yen | 25,000 yen |
| 300,001 yen ～ 500,000 yen | 40,000 yen |
| 500,001 yen ～ 800,000 yen | 60,000 yen |
| more than 800,000 yen | 80,000 yen |
| Tax Refund amount (20% of the Lump-Sum Withdrawal Payment) |
Business agency commission | Remittance charge |
| Less than 30,000 yen | 5,000 yen | Actual cost |
| 30,000 yen ～ 60,000 yen | 10,000 yen | |
| 60,001 yen ～ 120,000 yen | 15,000 yen | |
| more than 120,000 yen | 20,000 yen |
Consumption tax will be added to the business agency commission listed above.
