A03056《非居民纳税人享受税收协定待遇情况报告表（个人所得税A表）》.docVIP

A03056《非居民纳税人享受税收协定待遇情况报告表（个人所得税A表）》非居民纳税人享受税收协定待遇情况报告表（个人所得税A表）Reporting Form for Non-resident Taxpayer Claiming Tax Treaty Benefits(Form A for Individual 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: RMB 〇 自行申报 〇 扣缴申报 〇 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 　 Tax identification number of withholding agent 　 II. Basic Information of Non-resident Taxpayer 非居民纳税人中文名称Chinese name of non-resident taxpayer 　 Name of non-resident taxpayer in resident state (region) 　 Type of ID certificate 　 Number of ID certificate 　 Name of the applicable tax treaty 　 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)享受股息条款待遇填写 (I) Claiming Tax Treaty Benefits under the Article of Dividends 1．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 company 　 *2 Percentage of total share capital held, directly and indirectly, by the non-resident taxpayer in the dividend paying company 　 Amount of investment in the dividend paying company by the non-resident taxpayer 金额：Amount: 币种：Currency: （二）享受利息条款待遇填写  (II) Claiming Tax Treaty Benefits under the Article of Interest *3．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 indirectly 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