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/D1 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 Individual4 纳税人境内地址Address in China5 境内联系电话Telephone number in China 6
2、 境内邮政编码Postal code in China7 纳税人境外地址Address in home country8 境外联系电话Telephone number in home country9 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 agent15支付人或扣缴义务人纳税识别号Tax identification number of payer
3、 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Taxdeduction 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 treatment under DTA 22 本次 申请附报资料清单List of d
4、ocuments 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 before24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 taxpayer： 年 月 日 Y/M/D代理人印章或签字 stamp or signature of a
5、ttorney： 年 月 日 Y/M/D25 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 the applicant is a resident, or a separate certificate
6、 issued by such authority or representative could be attached)CertificationWe 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).Stamp or signature of the competent authority or its aut
7、horized 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 填表说明：Note1.本表适用于提出享受税收协定待遇审批申请的非居民。This form is applicable to non-resident applying for treatment under DTA.2.本表第 11 栏中项目按交易或合同名称填报。Fill in the name of
8、 the transaction or contract in Blank 11.6.本表第 18 栏按收入额填报的，本表第 19 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 18, the amount of tax deduction or exemption in Blank 19 is calculated on the bisis of taxable income inferred from the amount of gross income. The process of calculation shall be specified in “Additional information“.7.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 24 栏盖章或签名。The stamp or signature of taxpayer in Blank 24 is not required if the attorney is fully authorized in written form by the taxpayer.
