外国居民享受避免双重征税协定待遇申请表_知识

外国居民享受避免双重征税协定待遇申请表

2014-06-12 10:45

外国居民享受避免双重征税协定待遇申请表

Application for Treatment Under Double Taxation Agreement

税务局

To Tax Bureau

一、申请人事项Details of Claimant：

个人 individual	姓名Full name	国籍 Nationality
个人 individual	住所或居所 Domicile or residence	邮政编码 Postcode
公司或团体Corporation or other entity	名称Name
	总机构所在地	邮政编码
	Place of Head Office	Postcode
	实际管理机构所在地 Place of effective Management	邮政编码 Postcode
	注册所在地 Place of registration	邮政编码 Postcode

二、所得事项Details of Income：

股息 Dividends	支付人名称 Payer’s name
	地址Address		邮编Postcode
	支付金额 Amount of payment		支付日期 Date of payment
利息 Interest	支付人名称 Payer’s name
	地址Address		邮编Postcode
	支付金额 Amount of payment		支付日期 Date of payment
	合同签字日期 Date of contract		合同有效期 Period of contract
特许权使用费 Royalties	支付人名称 Payer’s name
	地址Address		邮编Postcode
	支付金额 Amount of payment		支付日期 Period of contract
	合同签字日期 Date of contract		合同有效期 Period of contract
个人劳务所得 Income of personal service	职业Profession
	支付人名称 Payer’s name
	地址Address		邮编Postcode
	支付金额 Amount of payment	所得项目 Item of income		支付日期 Date of payment

三、适用的避免双重征税协定 Applicable Double Taxation Agreement：

中华人民共和国同国签订的避免双重征税协定第条第款。

Paragraph ,Article of the Tax Agreement between the People’s Republic of China and .

四、声明Declaration：

我仅在此声明以上呈报事项准确无误。

I hereby declare that the above statement is correct and complete to the best of my knowledge and belief.

申请人签名或盖章：

Claimant (Signature of Seal)：

五、申请人居民身份证明（由申请人为其居民的缔约国主管税务机关填写）：或另附对方主管税务机关出具的专用证明。

Certificate of Resident Status of Claimant (For the use of responsible tax office of the Contracting state in which the claimant is a resident) or attach the special certificate of resident issued by responsible tax office of the Contracting State in which the claimant is a resident.

Certification

We certify that (claimant’s name)is a resident of according to the provision of paragraph , of Article in the Double Taxation Agreement between and the People’s Republic of China.

Claimant’s serial number： Date：

Signature or Stamp of tax office

以下由中国主管税务机关填写(The following for the use of responsible tax office of China only)：

编号（No.）：第号

收到申请表日期

Date of receipt of application

审核日期

Date of examination

审核意见

Examination report

主办人（签字）

Responsible officer

(Signature)

负责人（签字）

Chief officer

(Signature)

主管税务机关盖章

Stamp of tax
office

中华人民共和国国家税务总局

State Administration of Taxation The People’s Republic of China