1、非居民享受税收协定待遇审批申请表 Non-residents claim for treatment under Double Taxation Agreement(DTA) (for approval) 填报日期 Date 年 月 日 Y/ M/D 1 纳税人名称 Taxpayers name 2 纳税人纳税识别号 Taxpayers tax identification number 3 纳税人类型 Type of taxpayer 企业 Enterprise 个人 Individual 4 纳税人境内地址 Address in China 5 境内联系电话 Telephone numbe
2、r in China 6 境内邮政编码 Postal code in China 7 纳税人境外地址 Address in home country 8 境外联系电话 Telephone number in home country 9 境外邮政编码 Postal code in home country 10 序号 No. 11 项目 Item 12 所得类型 Type of income 13 纳税方式 Approach of tax payment 14 支付人或扣缴义务人名称 Name of payer or withholding agent 15 支付人或扣缴义务人纳税识别号 Ta
3、x identification number of payer or witholding agent 16 申请适用税收协定及条款 Applicable DTA and articles 17 是否属于关联交易 An associated transactionor not 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 21 符合享受税收协定待遇规定条件的理由 Reasons for enjoying
4、 treatment under DTA 22 本次 申请附报资料清单 List of documents attached to this application form 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 24 声 明 Declaration 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. 纳税人印章或签字 Stamp or signature of tax
5、payer： 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） Applicants Certificate of Resident Status(to be filled out by the competent authority or its authorized representative of the other contracting party of which th
6、e applicant is a resident, or a separate certificate issued by such authority or representative could be attached) Certification We hereby certify that (applicants name) is a resident of (name of the other contracting party)according to the provisions of Paragraph ,of Article in the (name of law). S
7、tamp 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 附件 3： 非居民享受税收协定待遇身份信息报告表（适用于个人） Personal information of non-residents claiming for treatment u
8、nder Double Taxation Agreement(DTA) (for individuals) 填报日期 Date 年 月 日 Y/M/D 纳税人基本情况 Taxpayers information 1 在缔约对方姓名 Name in the other contracting party 2 中文姓名 Name in Chinese 3 在缔约对方纳税识别号 Tax indentification number in the other contracting party 4 家庭成员姓名 Name of family member 5 与纳税人关系 relationship w
9、ith the taxpayer 6 经常居住地 habitual residence 7 备注 Additional information 构成缔约对方税收居民情况 : Qualification as a fiscal resident of the other contracting party 8 构成缔约对方税收居民的法律依据描述 : Legal provisions prescribing the status of the taxpayer as a fiscal resident of the other contracting party 9 构成缔约对方税收居民的事实情况
10、描述 : Description of facts based on which the taxpayer qualifies as a fiscal resident of the other contracting party 10 在缔约对方是否保有长期居 所 Does the taxpayer have permanent residence in the other contracting party? 是 Yes 否 No 11 在缔约对方是否取得长期居留权 Does the taxpayer have the right to permanently stay in the ot
11、her contracting party? 是 Yes 否 No 12 在缔约对方保有的投资额 Amount of investment kept in the other contracting party 13 最近连续 12 个月内在缔约对方连续或累计停留天数 Number of days of continuous stay or cumulative stays in the other contracting party in the past 12 months 14 是否保有缔约对方国籍 Does the taxpayer hold nationality of the ot
12、her contracting party? 是 Yes 否 No 从中国取得所得在缔约对方纳税情况 (限于列入税收协定适用范围的税种 ): Information of tax payment in the other contractiong party on the income derived from China (taxes covered by DTA only) 15 税种名称 Type of tax 16 适用税率或税率表 Effective tax rate(s) 17 享受缔约对方国内 减免税优惠的法律依据 及条文描述 Legal provisions prescribi
13、ng tax deduction or exemption enjoyed in the other contracting party 是否构成第三方税收居民 Whether a fiscal resident of a jurisdiction other than China & the other contracting party 18 是否在第三方负有居 民纳税义务 Is the taxpayer liable to tax for his worldwide income in a jurisdiction other than China & the other contrac
14、ting party? 是 Yes 否 No 第三方名称 Name of the jurisdiction 19 是否在第三方保有长期居所 Does the taxpayer have perment residence in a jurisdiction other than China & the other contracting party? 是 Yes 否 No 第三方名称 Name of the jurisdiction 20 是否在第三方取得长期居留权 Does the taxpayer have the right to permenantly stay in a jurisd
15、iction other than China & the other contracting party? 是 Yes否 No 第三方名称 Name of the jurisdiction 21 是否在第三方保有的投资额超过 缔约对方投资额 Does the amount of investment in a jurisdiction other than China & the other contracting party exceed that in the other contracting party? 是 Yes 否 No 第三方名称 Name of the jurisdicti
16、on 22 最近连续 12 个月内是否在第三方连续或累计超过 180 天 Does the taxpayer stay in a jurisdiction other than China & the other contracting party for a period or periods exceeding in the aggregate 180 days in the past 12 months? 是 Yes 否 No 第三方名称 Name of the jurisdiction 23 是否保有第三方国籍 Does the taxpayer hold the nationalit
17、y of a jurisdiction other than China & the other contracting party? 是 Yes 否 No 第三方名称 Name of the jurisdiction 是否构成中国税收居民 Whether a fiscal resident of China 24 在中国境内是否有住所 Does the taxpayer have domicile in China? 是 Yes 否 No 25 在中国境内是否保有长 期居所 Does the taxpayer have permanent residence in China? 是 Yes
18、否 No 26 是否取得在中国的长期居留权 Does the taxpayer have the right to permanently stay in China? 是 Yes 否 No 27 在最近纳税年度内在中国连续或累计停留天数 Number of days of continuous stay or cumulative stays in China in the past taxable year 28 在中国保有的投资额 Amount of investment in China 29 是否具有中国国籍 Does the taxpayer hold the nationalit
19、y of China? 是 Yes 否 No 填表说明： Note 1 本表为非居民享受税收协定待遇审批申请表附表，适用于在非居民享受税收协定待遇申请表第 3 栏中选择为个人的纳税人。 This form is attached to the form “Non-residents claim for treatment under Double Taxation Agreement(DTA) (for apprroval)“. Applicable when “individual taxpayer“ is selected in Blank 3 in that form. 2 本表第 4
20、栏中家庭成员包括配偶、未成年子女以及共同生活的其他抚养或赡养人员。 “Family member“ in Blank 4 includes spouse, dependant children, and other dependent family members living together. 3 本表第 6 栏中经常居住地是指除仅满足工作、学习需要的临时居住地以外的日常生活居住地。各家庭成员经常居住地不同的，应在备注栏中说明原因 。 “Habitual residence“ in Blank 6 refers to the residence for daily life, other
21、than temporary stay for work or study. If family members have different habitual residence, please specify the reasons in “Additional information“. 4 本表有关栏中长期居所包括拥有或承租的可供居住五年以上的任何居住场所。 “Permanent residence“ in this form includes any residential location owned or rented by the taxpayer available to l
22、ive for more than 5 years. 5 本表有关栏中投资仅指对不动产、经营性资产和有价证券的投资。有价证券投资按有价证券发行者所在地确定投资地。 “Investment“ only refers to real property, operating assets and securities. Location of security investment is determined by the location of securities issuer. 6 本表有关栏中长期居留 权是指居住达五年以上的居留权。 “The right to pemanently stay
23、“ refers to a right to stay for more than 5 years. 7 本表第 24 栏中住所按中华人民共和国个人所得税法及其实施条例和有关税收规定确定。 “Domicile“ in Blank 24 is determined by the Individual Income Tax Law of the Peoples Republic of China, Regulations for the Implementation of the Individual Income Tax law and other related provisions. 附件
24、4. 非居民享受协定待遇身份信息报告表（适用于企业） Personal Information of non-residnets claiming for treatment under Double Taxation Agreement(DTA)(for enterprise) 填报日期 Date 年 月 日 Y/M/D 构成缔约对方税收居民情况： Qualification as a fiscal resident of the other contracting party 在缔约对方的名称 Name in the other contracting party 中文名称 Name in
25、 Chinese 3 在缔约对方纳税识别号 Tax identification number in the other contracting party 4 在缔约对方的企 业类型 Business type in the other contracting party 具有独立纳税地位的营利实体 Business entity with independent tax status 不具有独立纳税地位的营利实体 Business entity without independent tax status 政府 Government 非营利组织 Non-profitable organiz
26、ation 其他 Others 5 备注 Additional information 6 构成缔约对方税收居民的国内法律依据描述 : Legal provisions prescribing the status of the taxpayer as a fiscal resident of the other contracting party 7 构成缔约对方税收居民的事实情况描述 : Description of facts based on which the taxpayer qualifies as a fiscal resident of the other contracti
27、ng party 从中国取得的所得在缔约对方纳税情况（限于列入税收协定适用范围的税种） Information of tax payment in the other contracting party on the income derived from China (taxes covered by DTA only) 8 序号 No. 9 税种名称 Type of tax 10 适用税率或税率表 Effective tax rate(s) 11 享受缔约 对方国内减免税优惠的法律依据及条文描述 Legal provisions prescribing tax deduction or e
28、xemption enjoyed in the other contracting party 最近一年内直接或间接持本企业权益份额达到以上的第三方股东情况： Information of shareholders holding directly or indirectly at least 10 per cent of shares of the applicant in the past year, who are from jurisdictions other than China & the contracting party 12 股东名称 Name 13 所在地 Locatio
29、n 14 持股比例 Share in % 在缔约对方的经营情况： Operation in the contracting party 15 最近一年在缔约对方的主要经营项目及业务描述 Description of major operation projects and business in the contracting party in the past year 16最近一年来源于缔约对方的收入总额 Total amount of gross income arising in the contracting party in the past year 17 最近一年在缔约对方的雇
30、员人数 Number of employees in the other contracting party in the past year 最近一年和将来与位于第三方的关联方交易支付情况： Transactions and payments to associated parties from jurisdictions other than China & the other contracting party in the past year and in the future 18 关联交易对方名称 Name of associated party 19 所在地 Location 2
31、0 交易类型 Type of transaction 21 支付金额 Amount of payment 填表说明： Note 1.本表为非居民享受税收协定待遇审批申请表的附表，适用于在非居民享受税收协定待遇申请表第 3 栏中选择企业的纳税人。 This form is attached to the form “Non-residents claim for treatment under Double Taxation Agreement(DTA) (for apprroval)“. It is applicable to the taxpayer who selects “Enterpr
32、ise“ in Blank 3(Type of tax payer) in that form. 2.本表第 4 栏中具有独立纳税地位的营利实体和不具有独立纳税地位的营利实体，按是否在缔约对方单独缴纳属于协定适用范围的所得税判定。选择其他类型的，应在第 5 栏备注中说明具体特征和性质。 “Business entity with independent tax status“ and “Business entity with dependent tax status“ in Blank 4 is determined according to whether the taxpayer is
33、independently liable in the other contracting party to income taxes covered by DTA. If “Others“ is selected, please specify the charateristics and nature in Blank 5 (Additional information). 3.本表各栏所称“所在地”指具有独立税收管辖权的国家或地区，第 13 栏和第 19 栏中的所在地按注册地或经常居住地填报。 “Location“ in this form refers to any independe
34、nt tax jurisdiction. “Location“ in Blanks 13 & 19 refers to place of registration or place of habitual residence as the case may be. 4.“事实情况描述”一栏需要填列按缔约对方法律构成税收居民的事实，例如缔约对方国内法采取注册地标准判定税收居民的，应说明企业注册地、注册时间等注册情况。 The Blank of “Description of facts“ refers to the facts based on which the taxpayer qualif
35、ies as a fiscal resident in accordance with laws of the other contracting party. For example, if the status of fiscal resident is determined by place of registration, the place and time of registration shall be provided. 5.第 18 栏至第 21 栏有关填报人与位于第三方的关联方交易支付情况，可仅填报需要向与位于第三方的关联方支付款项的资金借贷、特许权许可、提供技术或管理服务
36、和财产转让交易。 For “Transactions and payments to associated parties from jurisdictions other than China & the other contracting party“ from Blank 18 to 21, it is only applicable to the payment for transactions on loans, franchise & license, provision of technical or managerial service, and property alienation. 6.填报本表时可视需增加附页。 Additional pages can be attached if necessary.
