非居民享受收协定待遇备案报告表.docVIP

附件 １Annex 1 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　 年 　月　 日 Y/M/D 1纳税人名称 Taxpayers name 　 2 Taxpayers tax identification number 　 3 Type of taxpayer □企业 Enterprise□个人 Individual 4纳税人境内地址Address in China 　 5Telephone number in China 6境内邮政编码Postal code in China 　 7Address in home country 8境外联系电话Telephone number in home country 　 9Postal code in home country 　 10Is the taxpayer a fiscal resident of a jurisdiction other than China the other contracting party? □是 Yes□否 No 11如10栏选是，请列示第三方名称If yes is in Blank 10, please specify 　 12No. 13项目Item 14所得类型Type of income 15纳税方式Approach of tax payment 16支付人或扣缴义务人名称Name of payer or withholding agent 17支付人或扣缴义务人纳税识别号Tax identification number of payer or withholding agent 18适用的税收协定及条款Applicable DTA and articles 19是否属于关联交易An associated transaction or not 20收入额或应纳税所得额Amount of gross income or taxable income 21减免税额Tax deduction or exemption 22备注Additional information 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 23Reasons for enjoying treatment under DTA 　 　 　 　 　 　 　 　 24List of documents attached to this form ⑴ 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 25List of documents that have been submitted before ⑴ 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 26 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 attorney： 年 月 日Y/M/D 27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 ap