1、非居民纳税人享受税收协定待遇情况报告表（企业所得税 A 表）Reporting Form for Non-resident Taxpayer Claiming Tax Treaty Benefits(Form A for Enterprise Income Tax)（享受税收协定股息、利息、特许权使用费条款待遇适用）(Applicable to Tax Treaty Benefits under Articles of Dividends, Interest or Royalties)填表日期： 年 月 日Filling date: Y M D 货币单位：元人民币Currency unit:
2、RMB 自行申报 扣缴申报 退税Self-declaration Withholding declaration Tax refund一、扣缴义务人基本信息I. Basic Information of Withholding Agent扣缴义务人名称Name of withholding agent扣缴义务人纳税人识别号Tax identification number of withholding agent二、非居民纳税人基本信息II. Basic Information of Non-resident Taxpayer非居民纳税人中文名称Chinese name of non-resi
3、dent taxpayer 非居民纳税人在中国的纳税人识别号Tax identification number of non-resident taxpayer in China 非居民纳税人在居民国（地区）的名称Name of non-resident taxpayer in resident state (region)非居民纳税人在居民国（地区）纳税人识别号Tax identification number of non-resident taxpayer in resident state (region)非居民纳税人享受税收协定名称Name of the applicable tax
4、 treaty所得类型Type of income 股息 Dividends 利息 Interest 特许权使用费 Royalties三、扣缴义务人使用信息 III. Information for Use by Withholding Agent（一）享受股息条款待遇(I) Claiming Tax Treaty Benefits under the Article of Dividends1非居民纳税人类型Type of non-resident taxpayer（1）政府、政府机构 Government or governmental body （2）税收协定缔约对方政府直接或间接拥有至
5、少 20%股份的缔约对方居民公司 Resident company of the other tax treaty contracting party with no less than 20% of its shares held by the government of the other contracting party, whether directly or indirectly （3）税收协定缔约对方政府直接或间接全部拥有资本的其他实体 Other entity with all its capital held by the government of the other ta
6、x treaty contracting party, whether directly or indirectly （4）其他公司 Other companies （5）合伙企业 Partnership enterprises （6）其他组织类型 请说明 Please specify：_Other types of entity 2非居民纳税人直接拥有支付股息的公司的股份比例Direct shareholding percentage of the non-resident taxpayer in the dividend paying company3非居民纳税人直接拥有股份比例在取得股息
7、前的 12 个月内是否曾有低于 25%（不含 25%）的情况？Has the direct shareholding percentage of the non-resident taxpayer in the dividend paying company been less than 25% (excluding 25%) at any time during the 12 months prior to the declaration of the dividends? 是 Yes 否 No*4非居民纳税人直接或间接拥有支付股息公司的股份比例合计 Percentage of total
8、share capital held, directly and indirectly, by the non-resident taxpayer in the dividend paying company非居民纳税人在该公司的投资金额Amount of investment in the dividend paying company by the non-resident taxpayer金额：Amount:币种：Currency:（二）享受利息条款待遇(II) Claiming Tax Treaty Benefits under the Article of Interest5非居民纳
9、税人是否是税收协定列明利息所得免税组织或机构？Is the non-resident taxpayer listed as an organization or institution specifically exempt from source country tax on interest in the tax treaty? 是 Yes 否 No6非居民纳税人类型Type of non-resident taxpayer（1）税收协定缔约对方的政府、行政区、地方当局 Government, political subdivision, local authority of the ot
10、her tax treaty contracting party（2）税收协定缔约对方中央银行 Central Bank of the other tax treaty contracting party（3）银行 Bank（4）其他金融机构 Other financial institution（5）其他企业或组织Other business or organization7非居民纳税人是否完全为税收协定缔约对方的政府所有？ Is the non-resident taxpayer wholly-owned by the government of the other tax treaty
11、contracting party? 是 Yes 否 No*8贷款资金是否存在以下情况Do any of the following circumstances apply in respect of the loaned monies?（1）由税收协定缔约对方符合条件的政府或机构间接提供资金The loaned monies are indirectly provided by government or institution of the other tax treaty contracting party in circumstances in which such indirectl
12、y financed loans qualify for benefits under the terms of the treaty（2）由税收协定缔约对方符合条件的政府或机构提供担保A guarantee is provided by a government or institution of the other tax treaty contracting party in circumstances in which such guaranteed loans qualify for benefits under the terms of the treaty（3）由税收协定缔约对方
13、符合条件的政府或机构提供保险Insurance is provided by a government or institution of the other tax treaty contracting party in circumstances in which such insured loans qualify for benefits under the terms of the treaty*9如贷款资金由税收协定缔约对方符合条件的政府或机构间接提供资金或担保或保险，请填写符合条件的政府或机构全称Please provide the full name of the qualif
14、ied government or institution if loans/funds, a guarantee or insurance are indirectly provided by a qualified government or institution of the other tax treaty contracting party（三）享受特许权使用费条款待遇(III) Claiming Tax Treaty Benefits under the Article of Royalties10据以产生该项特许权使用费的权利或财产属于以下哪种类型？To which of th
15、e following types of right or property do the royalties fall into?（1）文学、艺术或科学著作Literature, artistic or scientific work（2）专利、商标、设计、模型、图纸、秘密配方或秘密程序Patent, trade mark, design, model, plan, secret formula or process（3）工业、商业、科学设备Equipment for industrial, commercial or scientific use（4）有关工业、商业、科学经验的信息Info
16、rmation concerning industrial, commercial and scientific experience（5）其他特许权使用费 Other royalties 11该所得是否属于飞机、船舶租赁所支付的特许权使用费？Is the income attributable to a royalty paid for aircraft leasing or ship chartering? 是 Yes 否 No12请简要描述据以产生特许权使用费所得的具体权利或财产。Please give a brief description of the specific right
17、or property from which the royalty income derives.（四）其他信息 (IV) Other Information13该项所得是否与非居民纳税人设在中国的常设机构或固定基地有实际联系？Is the income effectively connected with a permanent establishment or fixed base of the non-resident taxpayer in China? 是 Yes 否 No14非居民纳税人是否通过代理人取得该项所得？Did the non-resident taxpayer rec
18、eive the income via an agent? 是 Yes 否 No15非居民纳税人为该项所得的“受益所有人”的声明Statement by non-resident taxpayer as the “beneficial owner“ of the income提示：“受益所有人” 是指对所得或所得据以产生的权利或财产具有所有权和支配权的人。如果非居民纳税人不是来源于中国的股息、利息或特许权使用费所得的受益所有人，则不能享受税收协定待遇。Note: A “beneficial owner“ refers to a person that owns and has the righ
19、t to dispose of the income or the rights or property from which such income derives. A non-resident taxpayer who is not the beneficial owner of the dividends, interest or royalties sourced in China is not entitled to the tax treaty benefits. （1）非居民纳税人是否对所得或所得据以产生的财产或权利具有控制权或处置权？Does the non-resident
20、 taxpayer have control over or the right to dispose of the income or the property or rights from which such income derives? 是 Yes 否 No（2）非居民纳税人是否对所得或所得据以产生的财产或权利承担相应风险？Does the non-resident taxpayer bear the risks associated with the income or the property or rights from which such income derives? 是
21、 Yes 否 No（3）非居民纳税人据以取得该项所得的有关权利或财产是否为获得税收协定的减免税利益而安排？With respect to the property or rights from which the non-resident taxpayer derives the income, have arrangements been made in such a way so as to gain access to the treaty benefits of tax exemption or reduction? 是 Yes 否 No（4）声明：Declaration:我谨声明，我
22、为该项所得的受益所有人，我取得该项所得的有关权利并非为了获得税收协定利益而安排。I hereby declare that I am the beneficial owner of the income, and arrangements have not been made, with repect to the rights from which the income derives, for the purpose of gaining tax treaty benefits. 非居民纳税人签章或签字 年 月 日Seal or signature of non-resident taxp
23、ayer Y M D16享受税收协定待遇的优惠税率（或实际征收率）Preferential tax rate under tax treaty treatment (or actual tax rate) 四、税务机关管理采集信息 IV. Information for Use by Tax Authorities（一）享受股息条款待遇(I) Claiming Tax Treaty Benefits under the Article of Dividends*17非居民纳税人是否为税收协定缔约对方的上市公司？Is non-resident taxpayer a listed company
24、in the other tax treaty contracting party? 是 请填写问题 19Yes. Please answer Question 19 否 No*18非居民纳税人是否为税收协定缔约对方居民且在缔约对方上市的公司 100%直接或间接拥有（不含通过不属于中国居民或缔约对方居民的第三方国家或地区居民企业间接持有股份的情况）？Is the non-resident taxpayer held 100%, directly or indirectly, by a resident of the other tax treaty contracting party, whi
25、ch is a listed company in the other tax treaty contracting party as well (indirect shareholdings by residents of a third state or region, other than residents of China or the other tax treaty contracting party, is excluded )? 是 请填写问题 19Yes. Please answer Question 19 否 No*19上市证券交易所名称Name of the stock
26、 exchange 上市股票代码Stock code （二）享受利息条款待遇(II) Claiming Tax Treaty Benefits under the Article of Interest20贷款合同利率Interest rate for loan contract 同期市场利率Market interest rate of the same period还款条件Repayment terms 21非居民纳税人与利息支付人之间是否有关联关系？Is there any related party relationship between non-resident taxpayer
27、and interest payer? 是 Yes 否 No22在利息据以产生和支付的贷款合同之外，非居民纳税人与第三人之间是否存在在数额、利率和签订时间等方面相近的其他贷款或存款合同? Apart from the loan agreement in respect of which interest arises and is paid, are there any other loan or deposit contracts between the non-resident taxpayer and a third party which are similar in terms of
28、 the amount, interest rate, date of signing and other aspects? 是 请在下一题中说明 Yes. Please specify in the next question 否 No*23请简要说明非居民纳税人与第三人之间合同情况（包括第三人名称、第三人与非居民纳税人的关系、合同签约日期、金额、期限、利率、付息与还款条件、担保人等）Please give a brief account of the contract(s) entered into between the non-resident taxpayer and the thi
29、rd party (including the name of the third party, the relationship between the non-resident taxpayer and the third party, date of contract signing, contract amount, contract period, interest rate, interest and principal repayment terms, guarantor, etc.).（三）享受特许权使用费条款待遇 (III) Claiming Tax Treaty Benef
30、its under the Article of Royalties24对据以产生特许权使用费的权利或财产，非居民纳税人是否拥有权属证明?如有，可另附权属证明材料。Does the non-resident taxpayer have an ownership certificate with respect to the rights or property from which the royalties derive? If so, the copy of the certificate may be attached separately. 是 Yes 否 No25非居民纳税人与特许权
31、使用费支付人之间是否有关联关系？Is there a related party relationship between non-resident taxpayer and royalty payer? 是 Yes 否 No26在特许权使用费据以产生和支付的版权、专利、技术等使用权转让合同之外，非居民纳税人与第三人之间是否存在在有关版权、专利、技术的使用权或所有权方面的转让合同？Apart from transfer agreement under which the right to use copyright, patent, technology or other rights ari
32、ses and under which the royalty is paid, are there any other transfer agreements, between the non-resident taxpayer and a third party, concerning the right to use or ownship of related copyright, patent, technology or other rights? 是 请在下一题中说明 Yes. Please specify in the next question 否 No*27请简要说明非居民纳
33、税人与第三人之间合同情况（包括第三人名称、第三人与非居民纳税人的关系、合同签约日期、金额、期限、受让使用条件、收费方式等）Please give a brief account of the contract(s) entered into between the non-resident taxpayer and the third party (including the name of the third party, the relationship between the non-resident taxpayer and the third party, date of contr
34、act signing, contract amount, contract period, conditions of use by licensee, manner in which fees are to be paid, etc.).*28如果非居民纳税人因转让或许可专有技术使用权而取得特许权使用费，请回答下列问题Where the non-resident taxpayer has transferred or licensed the right to use know-how and derives royalties therefrom, please answer the f
35、ollowing questions（1）非居民纳税人是否派人员为该项技术的使用提供有关支持、指导等服务并收取服务费？Does the non-resident taxpayer send employees to provide assistance, guidance or other services related to the use of the know-how, and charge a service fee for this? 是 请回答下面两个问题Yes. Please answer the following two questions 否 No（2）非居民纳税人派遣人
36、员在中国为该项技术的使用提供有关支持、指导等服务连续或累计持续的时间（月数或天数）Please state the cumulative time which the dispatched employees spend in China, on a continuous or successive basis, in rendering the assistance, guidance or other services related to the use of the know-how (months or days basis)（3）非居民纳税人派人员为该项技术的使用提供有关支持、指导
37、等服务是否已构成设在中国的常设机构？Does the non-resident taxpayer, by sending employees to China to render the assistance, guidance or other services related to the use of the know-how, give rise to a permanent establishment? 是 Yes 否 No（四）其他信息 (IV) Other Information29请简要说明除持有该项所得据以产生的权利或财产外，非居民纳税人的其他经营活动情况和其他财产情况Ple
38、ase give a brief account of operating activities and assets of the non-resident taxpayer, other than the rights or property from which the income derives.注册资本：Registered capital:管理费用金额：General and administrative expenses:30非居民纳税人上一会计年度财务情况Financial position of the previous fiscal year of the non-res
39、ident taxpayer 董事费金额：Directors fees:工资薪金总额：Sum of employees wages and salaries:31非居民纳税人最近一次举行董事会情况Information on the non-resident taxpayers most recent board meeting时间：Time:地点：Location:32非居民纳税人是否有义务在收到所得的 12 个月内将所得的全部或绝大部分（60%以上）支付或派发给第三国（地区）居民?Is the non-resident taxpayer obligated to pay or distri
40、bute all or most of (above 60% of) the income to residents of a third state (region) within 12 months after the receipt of the income? 是 请填写下面 2 个问题Yes. Please fill in the following two questions 否 No收款方名称Name of recipient收款方居民国（地区）Resident state (region) of recipient支付比例Payment percentage支付时间Time o
41、f payment*33非居民纳税人在取得该项所得后的 12 个月内有义务对外支付或派发的情况Non-resident taxpayer is obligated to pay or distribute the income within 12 months after receipt *34请简要说明对该项所得进行上述处理的理由Please briefly account for the above treatment of the income. 35缔约对方国家（地区）对此项所得的税务处理情况 Tax treatment of the income in the other contr
42、acting party 不征税 免税 征税税率小于等于 12.5% 其他 Not liable to tax Exempt Tax rate less than or equal to 12.5% Others *36如果非居民纳税人通过代理人取得该项所得，请填写以下问题If the non-resident taxpayer receives the income through an agent, please fill in the following questions（1）代理人名称Name of the agent （2）代理人收费标准和条件Standard service ch
43、arge and terms of agency relationship（3）与代理相关的风险和收益是否由非居民纳税人承担？Does the non-resident taxpayer assume the risks and enjoy the benefits in relation to the assets held and income passing via the agent? 是 Yes 否 No（4）请简要说明代理关系双方的权利和义务。Please give a brief account of the right and obligations of both parti
44、es in the agency relationship.37非居民纳税人近三年是否有来源于中国境内其他地区的同类所得？Has the non-resident taxpayer received any income of the same type sourced in other regions within China over the past three years? 是 Yes 否 No*38非居民纳税人近三年是否就来源于中国境内其他地区的同类所得享受过税收协定待遇？ Has the non-resident taxpayer claimed tax treaty benefi
45、ts for the income of the same type sourced in other regions within China over the past three years? 是 Yes 否 No*39请说明非居民纳税人近三年就来源于中国境内其他地区的同类所得享受税收协定待遇的情况Please indicate the details of any tax treaty benefits claimed by the non-resident taxpayer for the same type of income sourced in other regions wi
46、thin China over the past three years.主管税务机关In-charge tax authority时间(年份)Time (year)所得金额Amount of income减免税金额Amount of tax reduction or exemption（1） （2） （3） （4） （5） 五、附报资料清单 V. List of Documents Attached40非居民纳税人自行选择提供的能够证明其符合享受协定待遇的其他资料清单List of other documents provided by the non-resident taxpayer on a voluntary basis to justify entitlement to tax treaty benefits（1） （2） （3） （4） （5）
