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For individual income tax return service

Do you receive income anywhere else the world,other than salary income?	Yes No
Do annual medical expenses exceed JPY100,000 for you and your family?	Yes No
Have you lived in Japan longer than 5 years?	Yes No
Is your salary paid outside Japan?	Yes No Both
Does your company pay fringe benefits? Rent, car, utilities・・・etc?	Yes No
Do you receive any dividends from Japanese corporations?	Yes No
Did you exercise your stock options during the last calendar year?	Yes No
Did you buy or sell a house in Japan during the last calendar year?	Yes No
Did you pay any income tax anywhere overseas during the last calendar year?	Yes No
Do you receive a salary from more than one company?	Yes No

Takeuchi Total Accounting Office

2-8-20, Maizuru, chuo-ku,Fukuoka-city, 810-0073 JAPAN

PHONE: 092-781-0251 FAX:092-781-0353

E-mail:office@takeuchi-kaikei.com

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