1、外国居民享受避免双重征税协定待遇申请审批表To_Tax Bureau Application for Treatment Under Double Taxation Agreement 申请人事项 Details of Claimant:一、申请人名称 Full name 国别Nationality个人Individual 住所或居所Domicile or residence邮政编码Postcode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公司或团
2、体Corporation or other entity 注册所在地Place of registration邮政编码Postcode二、所得事项 Details of Income:支付人名称 Payers name地址 Address 邮编 Postcode股息Dividends支付金额Amount of payment支付日期Date of payment支付人名称 Payers name地址 Address 邮编 Postcode支付金额Amount of payment支付日期Date of payment利息Interest合同签字日期Date of contract合同有效期Pe
3、riod of contract支付人名称 Payers name地址 Address 邮编 Postcode支付金额Amount of payment支付日期Date of payment特许权使用费Royalties合同签字日期Date of contract合同有效期Period of contract职业 Profession支付人名称Payers name地址 Address 邮编 Postcode个人劳务所得Income of personal service 支付金额Amount of payment所得项目Item of income支付日期Date of payment三、适
4、用的避免双重征税协定 Applicable Double Taxation Agreement:中华人民共和国同 签定的避免双重征税协定第 条第 款。Paragraph , Article of the Tax Agreement between the peoples 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
5、人签名或盖章： Claimant (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。CertificationWe certify that (claimants name ) is a resident of according to the provision of paragraph , of Article in the Double Taxation Agreement between and the peoples Republic of China.Claimants serial
6、 number : Date :Signature or Stamp of tax office以下由中国主管税务机关填写（The follow for the use of responsible tax office of China only）: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)主管税务机关（公章）Stamp of tax office
