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外国居民享受避免双重征税协定待遇申请表

工商税务- 税务申报征收 | 2015-04-09 12:13:25.343

外国居民享受避免双重征税协定待遇申请表

一、申请人事项 Details of Claimant： ,19

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 Place of Head Office	邮政编码 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 registrartion	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	合同签字日期 Date of contract		合同有效期 Period of contract	支付日期 Date of payment
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	合同签字日期 Date of contract		合同有效期 Period of contract	支付日期 Date of payment
个人劳务所得 Income of personal service	职业Occupation
	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__________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：________________

Clafmant (Signature or 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)

中华人民共和国国家税务总局

主管税务机关盖章

State Administration of Taxation The People`s Republic of China

Stamp of tax office