【样表】A《非居民纳税人税收居民身份信息报告表（.doc

【样表】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?? ? ??? ○ 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 Wihholding Agent 扣缴义务人名称Name of withholding agent 　 扣缴义务人纳税人识别号 Tax identification number of withholding agent Tax identification number of withholding agent: The withholding agent should provide its identification number as shown in the tax registration certificate. 二、非居民纳税人基本信息II. Basic Information of Non-residet axpayer 非居民纳税人中文姓名Chinese name of non-resident taxpayer Name of non-resident taxpayer in resident state (region): Fill in the full English name of the non-resident taxpayer as shown in his/her ID document, such as the full English name on the passport. 非居民纳税人在居民国（地区）姓名Name of no -resident taxpayer in resident state (region) 非居民纳税人身份证件类型Type of ID certificate Type of ID certificate: Fill in the name of the valid certificate that can identify the sole identity of the non-resident taxpayer, such as a passport.　 Number of ID certificate 　Number of ID certificate: Fill in the number of the ID document of the non-resident taxpayer, such as the passport number. Contact address nd postal code in China 　 Contact address and postal code in the rsident state (region) 　 Telephone number in Cina 　 Telephone number in resident state (region) 　 Resident staeregion) Resident state (region): Fill in the name of the independent tax jurisdiction where the non-resident taxpayer is a resident. Tax resident of Hong Kong or Macau SARs should indicate Hong Kong SAR or Macau SAR as appropriate 非居民纳税人享受税收协定名称Name of the applicable tax treaty 　 III. Informatin 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 resid