[참고서식 제39호 서식]

Issue Number			갑종근로소득에 대한 소득세납세필증명서 Tax clearance Certificate of Class A Earned Income															Period for Handling
No.																		Immediately
Taxpayer		① Name									③ Resident Registration No.
		② Address
		④ Department					⑤ Position							⑥ Period for Employment
Withholding Agent		⑦ Business Location												⑧ Te lephone No.
		⑨ Name of Company						⑩ Business Registration No.											⑪ Kind of Business
		⑫ Name of Representative										⑬ Resident Registration No.
⑭ Purpose of this Certificate																⑮ Quantity of Certificates Needed
I confirm the following information about your tax withheld as recorded in our tax whithholding book under Article 92, Paragraph 1(or 2)of the Enforcement Ordinance of the Income Tax Law.
Date	Amount of Income			Tax Amount	Date of Tax Payment				Date				Amount of Income				Tax Amount			Date of Tax Payment
19 . . . Withholding Agent Siganture
I hereby request you to certify that the tax amount described above is duly paid as of this day under the provisions of Income Tax Law. Applicant Signature To Director of District Taxation Office
The Korean Tax Authority undersigned certifies the above. 19 . . . Director of District Taxation Office Official Seal