Form descriptions - Japan: D-N

09.02.2017

Information is provided here about the forms and their use in relation to the holding of Japanese securities or relief and reclaim procedures with regard to withholding tax on income from them.

Declaration Letter – U.S. Investment Fund

Customers holding Japanese listed Equities, ETFs or REITs and/or Japanese Convertible bonds on behalf of U.S. investment vehicles (such as mutual funds etc.) for whom Part B on Form 17 is normally applicable may opt to complete the Declaration Letter instead of Part B on the Form 17 for relief at source.

The Declaration Letter is mandatory for standard refund.

N.B.: Form 17 is, however, in any case, needed for U.S. investment vehicles.

How many are provided?One per beneficial owner.
Who completes it?Beneficial owner.
How often is it provided?

Convertible bonds - Relief at source: valid until revoked (unless there is a change in the beneficial owner’s details).

Convertible bonds - Standard refund: per reclaim request.

Listed Equities, ETFs and REITs - Relief at source: valid for one year as from the date of issuance.

Listed Equities, ETFs and REITs - Standard refund: per reclaim request.
When is it provided?

Convertible bonds - Relief at source: at the latest, ten business days before each relevant income payment date by 10:00 CET.

Convertible bonds - Standard refund: at the latest, three months before the statutory deadline.

Listed Equities - Relief at source: at the latest, five business days after each relevant income record date by 10:00 CET.

Listed ETFs and REITs - Relief at source: at the latest, three business days after each relevant income record date by 10:00 CET.

Listed Equities, ETFs and REITs - Standard refund: at the latest, three months before the statutory deadline.

Copy or original?Original required.

Declaration Letter - <national> Pension Fund

Customers holding Japanese listed Equities, ETFs or REITs and/or Japanese Convertible bonds on behalf of beneficial owners for whom Part B of Form 17 is normally applicable may opt to complete the Declaration Letter instead of Part B on the Form 17 for relief at source.

Customers holding Japanese listed Equities, ETFs or REITs and/or Japanese Convertible bonds on behalf of French (e.g. SICAV and FCP) investment vehicles such as mutual funds have to complete the Declaration Letter for relief at source.

Customers holding Japanese Listed Equities, ETFs or REITs and/or Japanese Convertible bonds on behalf of tax exempt pension funds under DTT with Limitation On Benefits Article must complete and submit the relevant version of the "Declaration Letter - <national> Pension Fund”, which request various information from the pension fund for standard refund.

How many are provided?One per beneficial owner.
Who completes it?Beneficial owner.
How often is it provided?Once. Valid until revoked.
When is it provided?At the latest, three months before the statutory deadline.
Copy or original?Original required.

Excluded Securities Notice

If, on a given interest payment date, a customer holds Japanese Eurobonds in an account for which it has provided a Master Representation on behalf of a person who is not a Gross Recipient, it must provide Clearstream Banking with a duly completed and executed Excluded Securities Notice notifying Clearstream Banking that a portion of the interest payment for which it is provided is not eligible for exemption (full relief) from Japanese withholding tax.

How many are provided?One per Clearstream Banking account and per excluded interest payment.
Who completes it?Customer.
How often is it provided?Per interest payment.
When is it provided?At the latest, four business days before the first interest payment date by 10:00 CET.
Copy or original?Original required.

Form 17 Attachment Form for Limitation on Benefits Article

Customers holding Japanese listed Equities, ETFs or REITs and Japanese Convertible bonds on behalf of eligible beneficial owners under DTT with Limitation On Benefits Article must provide this form.

How many are provided?One per beneficial owner.
Who completes it?Beneficial owner.
How often is it provided?

Convertible bonds - Relief at source: valid until revoked (unless there is a change in the beneficial owner’s details).

Convertible bonds - Standard refund: per reclaim request.

Listed Equities, ETFs and REITs - Relief at source: in general valid for three years if any line of part A Section 3 of the form applies.

The Form 17 is valid for one year if any line of part B, C or D Section 3 of the form applies.

The validity of the form starts as from the date of submission of the Form 17 to the Japanese Tax Office.


Listed Equities, ETFs and REITs - Standard refund: per reclaim request.
When is it provided?

Convertible bonds - Relief at source: at the latest, 10 business days before each relevant income payment date by 10:00 CET.

Convertible bonds - Standard refund: at the latest, three months before the statutory deadline.

Listed Equities - Relief at source: at the latest, five business days after the first relevant income record date by 10:00 CET.

Listed ETFs and REITs - Relief at source: at the latest, three business days after each relevant income record date by 10:00 CET.

Listed Equities, ETFs and REITs - Standard refund: at the latest, three months before the statutory deadline.

Copy or original?Original required.

IRS Form W-9

The IRS form W-9 must be provided by each U.S. resident beneficial owner that holds FTRO and TEFRA Samurai bonds.

How many are provided?One per U.S. resident beneficial owner.
Who completes it?U.S. resident beneficial owner.
How often is it provided?Once. Valid until revoked, unless there is a change of beneficial owner details, such as address or name, in which case a new IRS Form W-9 must be provided.
When is it provided?At the latest, 20 calendar days after the first income payment date by 10:00 CET.
Copy or original?Original required.

Japanese Payment Handling Agent Certificate

A customer that is a Japanese Payment Handling Agent (PHA) and holds Japanese Eurobonds exclusively for beneficial owners who are individual residents of Japan or Japanese corporations certifies that all Japanese Eurobonds that it may hold from time to time in the account specified in the certificate are held on behalf of such beneficial owners.

A PHA that holds Japanese Eurobonds on behalf of any non-residents of Japan must follow the procedures for customers who are not PHAs.

The PHA Certificate is effective (until revoked by the customer) for all future interest payments made to the account(s) specified in the certificate.

How many are provided?One per Clearstream Banking account.
Who completes it?Customer.
How often is it provided?Once. Valid until revoked.
When is it provided?At the latest, four business days before the first interest payment date by 10:00 CET.
Copy or original?Original required.

Letter of Request to Clearstream Banking for Reclaim of Withholding Tax on Japanese Securities

This authorises Clearstream Banking to reclaim withholding tax from the Japanese Tax Authorities on the customer's behalf.

How many are provided?One per reclaim application.
Who completes it?Customer.
How often is it provided?Per reclaim application.
When is it provided?At the latest, three months before the statutory deadline.
Copy or original?Original required.

Master Representation for Debt Obligations issued outside Japan before 1 April 2010

In order to obtain exemption (full relief at source) from Japanese withholding tax, a customer must send Clearstream Banking a duly completed and executed Master Representation certifying that, unless it advises Clearstream Banking otherwise by sending an “Excluded Securities Notice” (see above), all Japanese debt obligations issued outside Japan before 1 April 2010 that it may hold from time to time in the specified account(s) are held on behalf of Gross Recipients.

How many are provided?One per Clearstream Banking account.
Who completes it?Customer.
How often is it provided?Once. Valid until revoked.
When is it provided?At the latest, four business days before the first interest payment date by 10:00 CET.
Copy or original?Original required.

Master Representation for Debt Obligations issued outside Japan on/after 1 April 2010

In order to obtain exemption (full relief at source) from Japanese withholding tax, a customer must send Clearstream Banking a duly completed and executed Master Representation certifying that, unless it advises Clearstream Banking otherwise by sending an “Excluded Securities Notice” (see above), all Japanese debt obligations issued outside Japan on/after 1 April 2010 that it may hold from time to time in the specified account(s) are held on behalf of Gross Recipients.

How many are provided?One per Clearstream Banking account.
Who completes it?Customer.
How often is it provided?Once. Valid until revoked.
When is it provided?At the latest, four business days before the first interest payment date by 10:00 CET.
Copy or original?Original required.

Notification Form for Withholding Tax exemption (Partnerships or Trust)

This form provides details regarding the beneficial owner that is a Partnerships or Trust only and its Qualified Financial Intermediary (QFI) and is valid for five years.

The applicant in the form should always be the ultimate beneficial owner of the securities and the applicable QFI to be mentioned in the form must be the last financial institution in the custody chain with which the beneficial owner has the account.

The QFI of the applicant will complete the QFI part and sign this on behalf of the beneficial owner.

Copies must be sent by email to tax@clearstream.com according to whether the customer holds the securities for itself or for a third party, as follows:

  • For customers holding proprietary assets, an electronic copy;
  • For customers holding client assets, a scanned copy. The original form must be sent by registered post upon verification of Clearstream Banking.
How many are provided?One per beneficial owner.
Who completes it?Beneficial owner and the QFI of the beneficial owner.
How often is it provided?Every five years.
When is it provided?Before the first investment.
Copy or original?Original required.

Notification Form for Amendment concerning Withholding Tax Exemption (Partnerships or Trust)

This form must be provided where there is any change of address, registered address or name of the beneficial owner or its QFI.

The applicant in the form should always be the ultimate beneficial owner of the securities and the applicable QFI to be mentioned in the form must be the last financial institution in the custody chain with which the beneficial owner has the account.

The QFI of the applicant will complete the QFI part and sign this on behalf of the beneficial owner.

Copies must be sent by email to tax@clearstream.com according to whether the customer holds the securities for itself or for a third party, as follows:

  • For customers holding proprietary assets, an electronic copy;
  • For customers holding client assets, a scanned copy. The original form must be sent by registered post upon verification of Clearstream Banking.
How many are provided?One per beneficial owner.
Who completes it?Beneficial owner and the QFI of the beneficial owner.
How often is it provided?Every five years.
When is it provided?As soon as a change in the beneficial owner or QFI details occurs.
Copy or original?Original required.