Important Notice to Shareholders living outside Japan and having

Important Notice to Shareholders living outside Japan and
having account with CCASS participant or securities company to
hold shares of the Company
If you are the shareholder living outside Japan and having the account with a CCASS
participant or a securities company to hold our shares (i.e. CCASS beneficial owner,
hereinafter, applicant), please be sure to read the following notices before applying for
withholding tax refund.
To apply for withholding tax refund, Japanese NTA (National Tax Agency) requests to
provide the statement showing receipt of dividend to meet the followings for application
review:
1) The statement an applicant provides should be a daily (not monthly) statement
showing receipt of dividend on the dividend payment date issued by CCASS
participant or securities company in principle.
2) The above daily statement should include the following information:
a. Name of applicant, that is, account holder, which should coincide with the
applicant’s name on the refund application form
b. Living address for the applicant
c. Account number with CCASS participant or securities company
d. Number of the Company’s shares applicable to the dividend paid
e. Payment date of dividend
f.
Record date of dividend (if possible)
g. Gross dividend amount per share before deduction of withholding tax (if
possible)
h. Net dividend amount per share after deduction of withholding tax
i.
Comment or note to show the Japanese withholding tax has already been
deducted (if possible)
j.
Whole net paid amount after deduction of withholding tax
If the notice or statement provided by applicant doesn’t meet the above requirements,
the refund of withholding tax may not be approved by NTA.
In addition, the address written by applicant on the refund application form and the one
shown on the statement issued by CCASS participant or securities company should be
same.
The refund application form should be written in clear block letters by applicant or in
1
typewritten form .
Best Regards
Legal Group / Dynam Japan Holdings Co., Ltd.
26 May 2016
Note:
If you have any queries in relation to the above notice, please contact the Company
shown below.
Tokyo Office
E-mail: [email protected]
Tel: +81-3-5850-3660
Legal Group
Dynam Japan Holdings Co., Ltd.
2-27-5, Nishi-Nippori, Arakawa-ku, Tokyo 116-8580, Japan
Hong Kong Office
Tel: +852-3769-0600
Unit A1, 32nd Floor, United Centre, 95 Queensway, Admiralty, Hong Kong
2
様式１(Form 1)
株式会社ダイナムジャパンホールディングス
DYNAM JAPAN HOLDINGS Co., Ltd
還付請求申請書
APPLICATION FORM FOR TAX REFUND
１.申請者情報 Details of Recipient of Refunds
氏名又は名称
Full name
個人の場合
住所又は居所
Individual
Domicile or residence
電話番号 Telephone Number:、
E メールアドレス E-mail address:
国籍
Nationality
法人その他の
本店又は主たる事務所の所在地
団体の場合
Place of head office or main
Corporation
office
or other
電話番号 Telephone Number:
entity
E メールアドレス E-mail address:
設立又は組織された場所
Place where the Corporation was
established or organized
事業が管理・支配されている場所
Place where the business is
managed or controlled
電話番号 Telephone Number
E メールアドレス E-mail address:
居住者としてこの配当に関して課税される国、納税
地※注1
Country where the recipient is taxable as resident
on Dividends mentioned in 2. below and the place
where he is to pay tax *Note 1
日本国内の恒久的施設の
名称
状況
Name
Permanent establishment
所在地
in Japan
Address
□有(Yes) , □無(No)
納税者番号 Taxpayer Identification Number*:
電話番号 Telephone Number:
If “Yes”, explain:
E メールアドレス E-mail address:
事業の内容
Details of Business
納税者番号とは、租税の申告、納付その他の手続を
*Note 1. The Taxpayer Identification Number is a number, code or symbol which is
行うために用いる番号､記号その他の符号でその手続をすべ
used for filing of return and payment of due amount and other procedures regarding
き者を特定することができるものをいいます。支払を受ける
tax, and which identifies a person who must take such procedures. If a system of
者が納税者番号を有しない場合や支払を受ける者の居住地
Taxpayer Identification Number does not exist in the country where the recipient
である国に納税者番号に関する制度が存在しない場合には
resides, or if the recipient of the payment does not have a Taxpayer Identification
納税者番号を記載する必要はありません｡
Number, it is not necessary to enter the Taxpayer Identification Number.
※注 1.
様式１(Form 1)
２. 株式の数量 Number of Shares
株式の数量
Number of shares (DYNAM JAPAN : 06889)
３.還付金の受領場所等に関する希望 Options for Receiving Your Refund
(1) 日本国内の銀行口座(含: ゆうちょ銀行の口座)または、日本国外の銀行口座を選択出来ます。源泉徴収税の還付金は日本円で支払われ、必要に応
じてご利用の銀行により指定された為替レートで当該銀行口座の現地通貨に自動的に変換されます。
You may opt to provide either a Japanese bank account (including an account of Japan Post Bank) or a bank account outside Japan. Refunds
of withholding taxes will be paid on Japanese yen and, if applicable, automatically converted into the denominated currencies of your
bank account at an exchange rate specified by your bank.
(2) 該当する箇所のみを記入して下さい。
Only enter your information in the corresponding fields.
受取希望場所
銀行
支店
預金種類及び口座番号
口座名義人
Receipt by transfer to:
Bank
Branch name or number
又は記号番号
Name of account holder
Type of account and
account number
日本国内の預金口座
A Japanese bank account
日本国外の預金口座
A bank account outside
Japan
支店住所（国名、都市名）Branch Address (Country, City):
４.代理人情報（本人以外が記載する場合）Details of Agent; If this form is prepared and submitted by an Agent,
Fill out the following columns.
代理人の資格
氏名（名称）
納税管理人の届出をした税務署名
Capacity of Agent in Japan
Full name
Name of the Tax Office where the Tax Agent is
registered
□ 納税管理人
Tax Agent
□ その他の代理人 Other Agent
電話番号 Telephone Number
住所（居所・所在地）
Domicile (Residence or location)
５.会社使用欄 For Company Use Only
（1）所得の種類
（2）所得の支払期
（3）所得の支払金
（4）（3）の支払金
（5）（4）の税額の
（6）正当な還付を
（7）還付を受けるべき金
Kind of Income
日
額
額から源泉徴収し
納付年月日
適用した場合に源
額（還付金返金日）
受付日
Due Date for
Amount paid
た税額
Date of Payment
泉徴収すべき税額
Amount to be refunded
(Receipt Date)
Payment
Withholding Tax
of （4）
Tax Amount to be
(Refund Date)
withheld under
(（4）－（6）)
on （3）
Tax correct paid.

Download Report