1、据 实 填 写非居民享受税收协定待遇备案报告表Non-residents claim for treatment under Double Taxation Agreement (DTA) (for record)填报日期 Date 20xx 年 xx 月 xx 日 Y/M/D1 纳税人名称 Taxpayers name某某某或某某公司2 纳税人纳税识别号 Taxpayers tax identification number税务登记证号3 纳税人类型 Type of taxpayer企业 Enterprise 个人 Individual4 纳税人境内地址Address in China 据实
2、填写5 境内联系电话Telephone number in China111111116 境内邮政编码Postal code in China 1111117 纳税人境外地址Address in home country8 境外联系电话Telephone number in home country 9 境外邮政编码Postal code in home country 10 纳税人是否构成任何第三方税收居民Is the taxpayer a fiscal resident of a jurisdiction other than China 10 dividend; 11 interest;
3、 12 royalties; 13 capital gains; 14 independent personal service income; 15 dependent personal service income; 17 income derived by artistes or sportsmen; 18 pensions; 20 payments for students education or training; 21 other income. All that can not be covered by business profit,dividend, interest,
4、royalties,capital gains, independent personal service income,dependent personal service income,income derived by artistes or sportsmen,pensions and payments for students education or training in accordance with the applicable articles of DTA,shall be characterized as “other income“.5.本表第 15 栏中纳税方式按类
5、型代号填写，类型代号为：自行申报；源泉扣缴。Choose from following codes for Blank 15 (Approach of tax payment): 1 Self-declaration; 2 Withholding at source.6.本表第 20 栏应优先按应纳税所得额填报；不能准确填报应纳税所得额的，按收入额填报。Fill in the amount of taxable income in Blank 20. If unable to fill in the amount of taxable income precisely, fill in the
6、 amount of gross income. 7.本表第 20 栏按收入额填报的，本表第 21 栏中的减免税额按照由收入额推算的应纳税所得额计算，并应在备注栏中说明推算过程。If the amount of gross income is filled out in Blank 20, the amount of tax deduction or exemption in Blank 21 is calculated on the basis of taxable income inferred from the amount of gross income. The process of calculation shall be specified in “Additional information“.8.纳税人全权委托代理人填报本表并附报书面授权委托书的，可不在本表第 26 栏盖章或签名。The stamp or signature of taxpayer in Blank 26 is not required if the attorney is fully authorized in written form by the taxpayer.
