非居民享受税收协定待遇审批申请表

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非居民享受税收协定待遇审批申请表

Non-resident's claim for treatment under Double Taxation Agreement(DTA) (for approval)

填报日期Date 年 月 日Y/ M/D

2纳税人纳税识3纳税人类1纳税人名称 Taxpayer's name 别号 型 Taxpayer's tax identification taxpayer number 4纳税人境内地址 Address in China number in China 8境外联系电7纳税人境外话 地址 Address in number in home country home country 10 序号 No. 11 项目 Item 12 所得类型 Type of 13 纳税方式 Approach of tax 14 支付人或扣缴义务人名称 Name of payer or withholding agent 15 支付人或扣缴义16 申请适用税17 是否属于关联交易 An associated transactionor not country 18 收入额或应纳税所得额 Amount of gross income or taxable income 19 减免税额 Tax deduction or exemption 20 备注 Additional information in home Telephone Postal code 编码 5境内联系电话 Telephone Postal code in China 9境外邮政6境内邮政编码 Type of □个人 Individual □企业 Enterprise 务人纳税识别号 收协定及条Tax identification number of payer or witholding agent 款 Applicable DTA and articles income payment 1

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21符合享受税收协定待遇规定条件的理由 Reasons for enjoying treatment under DTA ⑴ 22本次 申请附报资料清单 List of documents attached to this ⑸ application form ⑵ ⑶ ⑷ 23与本次申请享受税收协定待遇有关但以前提交的资料清单 List of documents that have been submitted before ⑴ ⑵ ⑶ ⑷ ⑸ 2

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我谨声明以上呈报事项准确无误。I hereby declare that the above information is true and correct. 24 声 明 Declaration 纳税人印章或签字Stamp or signature of taxpayer： 年 月 日Y/M/D 代理人印章或签字 Stamp or signature of attorney： 年 月 日Y/M/D 25纳税人居民身份证明（由纳税人为其居民的缔约对方税务主管当局或其授权代表填写，或另附由该税务主管当局或其授权代表出具的专用证明） Applicant's Certificate of Resident Status(to be filled out by the competent authority or its authorized representative of the other contracting party of which the applicant is a resident, or a separate certificate issued by such authority or representative could be attached) Certification We hereby certify that (applicant's name) is a resident of (name of the other contracting party)according to the provisions of Paragraph ,of Article in the (name of law). Stamp or signature of the competent authority or its authorized representative： Date(y/m/d) 26主管税务机关或其授权人印章或签字： Stamp or signature of the responsible tax office or its authorized representative 年 月 日Y/M/D

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