Report of Exemption & Deduction from Income,Report of Exemption & Deduction from Wage&Salary Income

[Tax Form 37] (Page1)
□ Report of Exemption & Deduction from Income
□ Report of Exemption & Deduction from Wage&Salary Income
Employee
Name

Resident(Foreign) Reg. No.

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Employer
Name
(Company Name)

Tax Registration No.

­

­

Personal
Deduc
tion
Basic Deduction
Additional (If applicable, mark “○”)
Relationship
Name
Age Limit
Resident
(Foreign)
Reg. No
Address
Aged
Disabled
Woman
Child Care
Myself

Spouse

Dependent
Father

born before
Dec.12,1943.

Mother

born before Dec.12,1948.

Child

born after
Jan.1,1983.

Child

born after
Jan.1,1983.

1. Age Limit is not applied to the Disabled
2. Qualified spouse and dependents with gross income of more than ￦1,000,000 for the tax year is not allowed.
3. Personal deduction is not allowed in case your spouse and dependents are already claimed by other taxpayer.
4. Additional
A) Woman :A head of household with a family to support as a woman, or, a woman who has a spouse.
B) Child Care : The child should be age 6 and under, and it is an optional deduction to choose with
education deduction based on expenses which was paid for child before entering an elementary school.
C) Age Limit : born before Dec. 31, 1938. born after Jan. 1, 1997.
Special
Deduction
Details of Expenditure Items
Insurance
Premium
Insurances
premium
￦
Insurance for the Disabled
premium
￦
Medical
Expenses
Qualified medical expenses ①
expenses
￦
For the Aged or the Disabled ②
expenses
￦
Total medical expenses (①+②)
expenses
￦
Education
Expenses
For Oneself
(include the graduate student)
Tuition
￦
For Child before entering an elem entary school ()
Tuition and
related expenses
￦
For Students ()
(elementary, secondary, high school)
Tuition
￦
For Undergraduates ()
(college or university)
Tuition
￦
For the Disabled ()
Tuition and
related expenses
￦
1. Insurance : Life & Damage & Accident & Fire & Burglary Insurance and insurance similar thereto.
2. Medical Expense : The total amount specified in the Certificate of Medical Expenses.
3. Education Expense for the Disabled : Special education expense paid to authorized institute for yourself, your spouse or dependents.
4. Enter the number of persons eligible for Education Expenses in the brackets

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