[Tax Form 37] <Revised on May 13, 2015>

(Page 1)

Report of Deduction․Tax Credit from Income

/ Report of Deduction․Tax Credit from Wage & Salary Income

(For the Year-end Tax Settlement of         Income)

※ An employee should fill in and submit this form to his/her withholding agent with documentary evidence. The withholding agent should check if the submitted form and attached documents are correct, calculate the tax amount for the employee's wage and salary income and immediately issue a withholding receipt to the employee. Later, when it is found out that the employee paid more than he had to, the withholding agent shall pay back the overpaid tax amount.

Employee Name

Resident(Alien) Reg. No.

-

Employer(Company) Name

Tax Registration No.

-        -

Householder status

Householder □   Member □

Nationality

(Nationality code:        )

Period Attributable

~

Period for exemption

～

Residency

Resident □   Non-resident □

State of Residence

( State Code :         )

Change for Personal Deduction

Same as before □  Changed □

※ If the list of personal deduction is the same that of the last year, do not submit a copy of resident registration certificate.

I  Personal Deduction · Tax Credit List

Personal Deduction

Description

Special Deduction․Tax Credit

Relationship code

Name

Basic

Aged

New born/

adopted

Insurance Premium

(Health Insurance Premium included)

Medical

Expenses

Education

Expenses

Credit Card Usage Deduction

Donation

Citizen/

Foreigner

Resident(Alien)

Reg. No.

Women

Single Parent

Disabled

age 6 or below

Health․

Employ

ment etc

Guaranteed

Guaranteed

for Disabled person

Credit Card

(excluding the usage in traditional markets and public transportation)

Debit Card

(excluding the usage in traditional markets and public transportation)

Cash Receipt

(excluding the usage in traditional markets and public transportation)

Amount spent in traditional markets

Amount spent in public transportation

No. of people eligible for personal deduction

(No. of multiple children:    )

NTS Data

Other Data

0

○

NTS Data

(Myself)

Other Data

NTS Data

-

Other Data

NTS Data

-

Other Data

NTS Data

-

Other Data

NTS Data

-

Other Data

Note

1. Relationship code

Category	Relation code	Category	Relation code	Category	Relation code
Taxpayer himself/herself (Article 50①1 of Income Tax Act)	0	Taxpayer's linear ascendant (Article 50①3․가 of Income Tax Act)	1	Spouse' linear ascendant (Article 50①3․가 of Income Tax Act)	2
Spouse (Article 50①2 of Income Tax Act)	3	Taxpayer's linear descendant (childrenㆍ adopted children) (Article 50①3․나 of Income Tax Act)	4	Spouse' linear descendant (Except subjects of code 4) (Article 50①3․나 of Income Tax Act)	5*
Sibling (Article 50①3․다 of Income Tax Act)	6	Recipient(Except subjects of code 1~6) (Article 50①3․라 of Income Tax Act)	7	Fostered child (Article 50①3․마 of Income Tax Act)	8

* If a linear descendant or his/her spouse is handicapped, include the spouse.

※ Relation codes from 4 to 6 are the relations with the taxpayer himself/herself or with the taxpayer's spouse

2. Age criteria

A. Preferential treatment for senior citizens : Born on/before Dec. 31,(    ). (Aged 70 or older: deduction of ￦1,000,000)

Age 6 or below : Born on/after Jan. 1,(    ).(Where a resident subject to basic deduction has more than two dependant children under age 6, 2 children (150,000 won), over 2 children (150,000 won + 150,000 won each from the third child)

3. Woman deduction is only applicable to female wage & salary income earners.

4. If you or your dependents are disabled, please enter the relevant code.

Classification	A disabled person specified in the "Act on Welfare of Persons with Disabilities"	A wounded and disabled person who does not have the ability to work specified in the "Act on the Honorable Treatment and Support of Persons, etc. of Distinguished Services to the State"	A severely-wounded patient who needs continued treatment
Code	1	2	3

5. Citizen/foreigner :  Citizen=1, Foreigner=9. If a wage & salary income earner is a foreigner, specify the nationality refer to the table of nationality code.

6. In the column of "Debit card," the usages prescribed in Article 126-2(1)4 of the Restriction of Special Taxation Act including debit card usage under Article 2 of the Specialized Credit Financial Business Act (excluding the amount spent in traditional markets and public transportation) should be entered.

210㎜×297㎜(일반용지 60g/㎡(재활용품))

						(Page 2)
Items		Expenditure Details					Classification	Amount	Limit	Deduction Amt.
II Pension remium Deduction	Pension Premium (National Pension, Public Employee Pension, Military Pension, Teachers' Pension, etc.)	National Pension Contribution		Previous Place			Premium		Total Amt.
				Current Place			Premium		Total Amt.
		Other Public Pension Contribution		Previous Place			Premium		Total Amt.
				Current Place			Premium		Total Amt.
		Subtotal
III Special Deduction	Insurance	Health Ins. (Elderly Long-term Care Ins. Included)		Previous Place			Premium		Total Amt.
				Current Place			Premium		Total Amt.
		Employment Ins.		Previous Place			Premium		Total Amt.
				Current Place			Premium		Total Amt.
		Subtotal
	Housing Funds	Housing Rental Loans		If borrowed from financial institutions or private loan providers			principle / interest
				If borrowed from individuals
		Monthly rent					Rent amount
		Long- term Mortgage Loan	Borrowed before 2011	Less than 15 Years			interest
				15 Years - 29 Years
				Over 30 Years
			Borrowed after 2012 (15 years or more)	Fixed interest rate or Non-deferred repayment loan
				Other loans
			Borrowed after 2015	Over 15 Years	Fixed interest rate, Non-deferred repayment loan
					Fixed interest rate or Non-deferred repayment loan
					Other loans
				10 Yrs-15 Yrs	Fixed interest rate or Non-deferred repayment loan
		Subtotal
IV Other Deduction	Individual Pension Savings (opened before 2000)						Payment		￦720,000 or 40%
	Deductions for Contribution of Small-sized Company and Self-employed Mutual aid association						Payment
	House-purchasing Savings	Subscription deposit					Payment
		Worker's home purchasing saving					Payment
		Housing Total subscription saving					Payment
		Subtotal
	Investment Assn. Deduction	Invested on 2012					Amount of investment
		Invested on 2013					Amount of investment
		Invested on 2014					Amount of investment
		Invested after 2015					Amount of investment
		Subtotal
	Credit Card Usage Deduction	① Credit cards (excluding the usage in traditional markets and public transportation)
		② Debit cards (excluding the usage in traditional markets and public transportation)
		③ Cash Receipt (excluding the usage in traditional markets and public transportation)
		④ Amount spent in traditional markets
		⑤ Amount spent in public transportation
		Subtotal (①+②+③+④+⑤)
		⑥ Amount spent by credit card, etc. (2013)
		⑦ Amount spent by credit card, etc. (2014)
		⑧ Amount spent from additional deduction rate (2013)
		⑨ Amount spent from additional deduction rate (2nd half of 2014 or 1st half of 2015)
	Contributions of the employee stock ownership association						Contribution
	Donations of the employee stock ownership association						Donation Amt.
	S/M Enterprises Maintaining Employment						Amount of wage cut
	Interest repayment amount of Jeonse (lease on deposit basis) that does not need a lump sum of money						Contribution
	Long-term collective investment securities						Payment
210mm×297mm[백상지 80g/㎡(재활용품)]

									(Page 3)
Items		Detail of Deducton․Tax Credit from Income
V Tax Examption & Tax Credit	Tax Exemption	Foreign workers	Purpose of Entry			□ Convention b/w Government □ Technology Importation Contract □ Exemption under Restriction of Special Taxation Act □ Exemption under Tax Treaty
			Date of making a technology importation contract or starting to provide labour									Due date for exemption period
			Exemption on wage&salary income of foreign workers					Date of acceptance							Date of submission
			Exemption on wage&salary income under the tax treaty					Date of acceptance							Date of submission
		Exemption on the employee in SMEs						Date of employment							Due date for exemption period
	Tax Credit	Kinds of Tax Credit						Details					Limit			Amount applicable for deduction		Deductible ratio		Tax Credit
		Pension account		Scientific technician				Payment										12% or 15%
				Guarantee of Workers' Retirement Benefits				Payment
				Pension savings				Payment
				Subtotal
		Special Tax Credit		Insurance	Indemnity Ins. (life, accident, etc.)			Premium					￦ 1,000,000					12%
					Insurance for the disabled			Premium					￦ 1,000,000					15%
					Subtotal
				Medical Expenses	Yourself, The aged, The Disabled, subfertility treatment			Expenses										15%
					For Other dependents			Expenses
					Subtotal
				Educational Expenses	Yourself			Tuition					Total Amt.					15%
					For Child before entering an elementary school (No. )			Tuition etc.					3 mil/person
					For Students (No. ) (elementary, secondary, high)			Tuition					3 mil/person
					For Undergraduates (No. ) (college or university)			Tuition					9 mil/person
					For the disabled (No. )			Tuition etc.					Total Amt.
					Subtotal
				Donation	Political donation		Under ￦ 100,000	Donation Amt.										100 /110
							Above ￦ 100,000	Donation Amt.										15% (25%)
					Legal donation			Donation Amt.
					Donations of the employee stock ownership association			Donation Amt.
					Designated Donation			Donation Amt.
					Subtotal
		Foreign Tax						Foreign Source Income
								Amt. Paid(Foreign Currency)
								Amt. Paid(￦)							-
								Country							Date of Payment
								Date of Submission of Application							Overseas Working Place
								Working Period							Position
		Home Mortgage Interest						Interest Paid							30%
		Monthly rent						Expenses							10%
In accordance with the Article 140 of the Income Tax Act, I hereby file this report.
Date: . ,
Taxpayer :									(Signature)
VI Additional dispatched documents
1. Do you submit an application form for flat tax rate of foreign employee?														Yes □ No □
2. Details of previous company		Company Name						Previous Total Wage & Salary						The Receipt Attached? Yes □ No □
		Tax Reg. No						Previous Final Tax Liability
3. Submission of statement of income deduction․tax credit for pension․savings O("Yes") □ X("No") □								Submission ( ) ※ If you apply for income deduction․tax credit for pension accounts, house-purchasing savings, etc. you should submit the corresponding statement.
4. Submission of statement of income deduction·tax credit for monthly rent․payment of principle and interest of home rental loans borrowed from individuals O("Yes") □ X("No") □								Submission ( ) ※ If you apply for income deduction·tax credit for monthly rent․payment of principle and interest of home rental loans borrowed from individuals, you should submit the corresponding statement.
5. Other documents					① Details of medical expenses( ), ② Statement of donation ( ), ③ Other documentary evidence for deduction·tax credit ( )
Note
1. The taxpayer should file the final return of global income tax unless he or she included the wage & salary from the previous company in the year-end tax settlement. Otherwise, the taxpayer will be subject to penalty taxes. 2. The taxpayer him-/herself does not have to directly enter the pension premium, national health insurance, employment insurance of the current company on the form. 3. The Deduction Amount section does not have to be filled by the employee when he/she submits this form to the withholding agent.
210mm×297mm[백상지 80g/㎡(재활용품)]