外国居民享受避免双重征税协定待遇申请表

1/7外国居民享受避免双重征税协定待遇申请表税务局外国居民享受避免双重征税协定待遇申请表TOTAXBUREAUAPPLICATIONFORTREATMENTUNDERDOUBLETAXATIONAGREEMENT一、申请人事项DETAILSOFCLAIMANT,19个人INDIVIDUAL姓名FULLNAME国籍ATIONALITY住所或居所DOMICILEORRESIDENCE邮政编码POSTCODE公司或团体CORPORATIONOROTHERENTITY2/7名称AME总机构所在地PLACEOFHEADOFFICE邮政编码POSTCODE实际管理机构所在地PLACEOFEFFECTIVEMANAGEMENT邮政编码POSTCODE注册所在地PLACEOFREGISTRARTION邮政编码POSTCODE二、所得事项DETAILSOFINCOME股息DIVIDENDS支付人名称PAYERSNAME地址ADDRESS邮编POSTCODE支付金额AMOUNTOFPAYMENT3/7支付日期DATEOFPAYMENT利息INTEREST支付人名称PAYERSNAME地址ADDRESS邮编POSTCODE支付金额AMOUNTOFPAYMENT合同签字日期DATEOFCONTRACT合同有效期PERIODOFCONTRACT支付日期DATEOFPAYMENT特许权使用费ROYALTIES支付人名称PAYERSNAME地址ADDRESS邮编POSTCODE支付金额AMOUNTOFPAYMENT4/7合同签字日期DATEOFCONTRACT合同有效期PERIODOFCONTRACT支付日期DATEOFPAYMENT个人劳务所得INCOMEOFPERSONALSERVICE职业OCCUPATION支付人名称PAYERSNAME地址ADDRESS邮编POSTCODE支付金额AMOUNTOFPAYMENT所得项目ITEMOFINCOME支付日期DATEOFPAYMENT三、适用的避免双重征税协定APPLICABLEDOUBLETAXATIONAGREEMENT5/7中华人民共和国同签订的避免双重征税协定第条第款。PARAGRAPH,ARTICLEOFTHETAXAGREEMENTBETWEENTHEPEOPLESREPUBLICOFCHINAAND四、声明DECLARATION我仅在此声明以上呈报事项准确无误。IHEREBYDECLARETHATTHEABOVESTATEMENTISCORRECTANDCOMPLETETOTHEBESTOFMYKNOWLEDGEANDBELIEF申请人签名或盖章CLAFMANTSIGNATUREORSEAL五、申请人居民身份证明（由申请人为其居民的缔约国主管税务机关填写）；或另附对方主管税务机关出具的专用证明。CERTIFICATEOFRESIDENTSTATUSOFCLAIMANTFORTHEUSEOFRESPONSIBLETAXOFFICEOFTHECONTRACTINGSTATEINWHICHTHECLAIMANTISARESIDENTORATTACHTHESPECIALCERTIFICATEOFR6/7ESIDENTISSUEDBYRESPONSIBLETAXOFFICEOFTHECONTRACTINGSTATEINWHICHTHECLAIMANTISARESIDENTCERTIFICATIONWECERTIFYTHATCLAIMANTSNAMEISARESIDENTOFACCORDINGTOTHEPROVISIONOFPARAGRAPH,OFARTICLEINTHEDOUBLETAXATIONAGREEMENTBETWEENANDTHEPEOPLESREPUBLICOFCHINACLAIMANTSSERIALNUMBERDATESIGNATUREORSTAMPOFTAXOFFICE以下由中国主管税务机关填写THEFOLLOWINGFORTHEUSEOFRESPONSIBLETAXOFFICEOFCHINAONLY编号NO第号收到申请表日期DATEOFRECEIPTOFAPPLICATION审核日期DATEOFEXAMINATION审核意见EXAMINATIONREPORT主办人（签字）7/7RESPONSIBLEOFFICERSIGNATURE负责人（签字）CHIEFOFFICERSIGN