A03054《非居民纳税人税收居民身份信息报告表（个人适用分析.docVIP

A03054《非居民纳税人税收居民身份信息报告表（个人适用）》 非居民纳税人税收居民身份信息报告表（个人适用） Information Reporting Form of Tax Residence Status of Non-resident Taxpayer For Individuals) 填报日期：　 年　月　日Filling date: Y M D ○ 自行申报 ○ 扣缴申报 ○ 退税  Self-declaration Withholding declaration Tax refund 一、扣缴义务人基本信息I.Basic Information of Wi hholding 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 非居民纳税人中文姓名Chinese name of non-resident taxpayer 　 Name of no -resident taxpayer in resident state (region) 　 Type of ID certificate 　 Number of ID certificate 　 Contact address and postal code in China 　 Contact address and postal code in the r sident state (region) 　 Telephone number in China 　 Telephone number in resident state (region) 　 Resident state (region) 　 Name of the applicable tax treaty 　 III. Informati n for Use by Withholding Agent 提示：“税收居民”是指符合缔约国国内税法中对居民定义的人，包括企业和个人。如果非居民纳税人不是需享受税收协定缔约对方的税收居民，则不能享受税收协定待遇。Note: The term tax resident means any person (e.g. an enterprise or individual) who, under the domestic tax law of a contracting party to the ta treaty, shall be regarded as a resident. If the non-resident taxpayer is not a resident of the other contracting party to the tax treaty, he/she shall not be entitled to the treatment under the tax treaty. 1、请引述非居民纳税人构成缔约对方税收居民的缔约对方国内法律依据： Please ci e the domestic legal basis based on which the non-resident taxpayer qualifies as a tax resident of the other contracting party: 2、请简要说明非居民纳税人能构成缔约对方税收居民的事实情况： Please briefly describe the facts based on which the non-resident taxpayer qualifies as a t x resident of the other contracting party: 3、声明： Declaration:   我谨声明，我为需享受税收协定缔约对方的税收居民，我成为缔约对方税收居民并非为了获得税收协定利益而安排。 I hereby declare that I am a tax resident of the other contracting party to the tax treaty and the purpose of becoming such a tax resident is not t