外國居民享受避免雙重征稅協(xié)定待遇申請表

1、外國居民享受避免雙重征稅協(xié)定待遇申請表Application for Treatment Under Double Taxation Agreement申請人事項(xiàng) details of Claimant:個(gè)人 Individual姓名Full Name國籍 Nationality住所或居所 Domicile or Residence郵政編碼Postcode公司或團(tuán)體 Corporation or other entity名稱Name總機(jī)構(gòu)所在地Place of HeadOffice郵政編碼Postcode實(shí)際管理機(jī)構(gòu)所 在地Place ofEffectiveManagement郵政編碼Post

2、code注冊所在地 Place of Registration郵政編碼Postcode、所得事項(xiàng) Details of Income股息 Dividends支付人名稱 Payer 's name地址 Address郵編 post code支付金額 Amount of payment支付日期 Date of payment利息Interest支付人名稱 Payer 's name地址 Address郵編 post code支付金額 Amount of payment支付日期 Date of payment合同有效期Period of contract支付日期 Date of pa

3、yment特許權(quán)使 用費(fèi)Royalties支付人名稱 Payer 's name地址 Address郵編 post code支付金額合同簽字合同有效支付日期Amount of payment日期 Date of payment期Period of contractDate of payment個(gè)人勞務(wù) 所得Income of personal service職業(yè)Occupation支付人名稱 Payer 's name地址 Address郵編Postcode支付金額 Amount of payment所得項(xiàng)目 Item of income支付日期 Date of payment

4、三、適用的避免雙重征稅協(xié)定 Applicable Double Taxation Agreement 中華人民共和國同 簽訂的避免雙重征稅協(xié)定第 / 條第 / 款；Paragraph /, Article /, of the Double Taxation Agreement between the People 's Republic of China and /.四、聲明 Declaration ： 我謹(jǐn)在此聲明以上呈報(bào)事項(xiàng)準(zhǔn)確無誤。I hereby declare thatthe above statement is correct and complete to thebest

5、 of my knowledge and belief.申請人簽名或蓋章： /Claimant (Signature or Seal)：/五、申請人居民身份證明(由申請人為其居民的締約國主管稅務(wù)機(jī)關(guān)填寫)；或 另附對方主管稅務(wù)機(jī)關(guān)出具的專用證明。Certificate of Resident Status of Claimant (For the use of responsible tax office of theContracting State in which the Claimant is a resident)or attach the special certificate o

6、f resident issued by responsible tax office of the Contracting State in which the Claimant is a resident.CertificationWe certify that / (claimant's name) is a residentof / according to the provision of paragraph /, of Article / in the Double TaxationAgreement between / and the People' s Repu

7、blic of China.Claimant ' s serialnumber: Date:Signature or Stamp of Tax Office:以下由中國主管稅務(wù)機(jī)關(guān)填寫 (The following for the use of responsible tax office of China only)編號（ No.）：第 號收到申請表日期 Date of receipt of application審核日期 Date of examination審核意見 Examination Report主辦人(簽字) Responsible officer (signature)

8、負(fù)責(zé)人(簽字) Chief officer (signature)主管稅務(wù)機(jī)關(guān)蓋章Stamp of tax office中華人民共和國國家稅務(wù)總局 State Administration of Taxation The People 's Republic of China關(guān)于填寫外國居民享受避免雙重征稅協(xié)定待遇申請表的說明一、填報(bào)范圍和程序（一）本表適用同中華人民共和國簽訂避免雙重征稅協(xié)定 （以下簡稱稅收協(xié) 定）國家居民取得來源于中國的股息、利息、特許權(quán)使用費(fèi)，以及個(gè)人勞務(wù)所得 申請享受稅收協(xié)定待遇填報(bào)。（二）本表由受益所有人或所得取得人填寫，一式兩份，一并送交支付人， 由支付人報(bào)送當(dāng)?shù)囟悇?wù)機(jī)關(guān)， 當(dāng)?shù)囟悇?wù)機(jī)關(guān)審核認(rèn)可后， 退還支付人一份據(jù)以執(zhí) 行。二、本表填寫說明（一）申請人事項(xiàng)：1、個(gè)人住所或居所填寫申請人在稅收上為其居民國家的住所或居所地址及 郵政編碼。2、公司或團(tuán)體名稱填寫公司或團(tuán)體的全稱；總機(jī)構(gòu)、實(shí)際管理機(jī)構(gòu)或注冊 所在地，填寫申請人在稅收上為其居民國家的總機(jī)構(gòu)所在地、 實(shí)際管理機(jī)構(gòu)所在 地或注冊所在地的地址及郵政編碼。（二）所得事項(xiàng)： 個(gè)人勞務(wù)所得中的職業(yè)填寫申請