外国居民享受避免双重征税协定待遇申请表

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1、外国居民享受避免双重征税协定待遇申请表                税务局To             TaxBureau         ApplicationforTreatmentUnderDoubleTaxataionAgreementTaxBureau         ApplicationforTreatmentUnderDoubleTaxataionAgreement一、申请人事项DetailsofClaimant：                             日期Date    年year   个人Individual姓名Fullname 国籍Natio

2、nality 住所或居所Domicileorresidence 邮政编码Postcode 公司或团体Corporationorotherentity名称Name 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Placeofregistration 邮政编码Postcode  二、所得事项DetailsofIncome:股息Dividends支付名称Payer'sname 地址Address 邮编Postcode 支付金额Amountofpayment

3、 支付日期DateofPayment 利息Interest支付名称Payer'sname 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支付名称Payer'sname 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 个人劳务所得Incomeofp

4、ersonalservice职业Occupation 支付名称Payer'sname 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ApplicableDoubleTaxationAgreement:中华人民共和国同    国签订的避免双重征税协定第 条第 款。Paragraph ,Article oftheTaxAgreementbetweenthepeople’sRepublicofChinaand     .. 四、声明Declaration:我

5、仅以此声明以上呈报事项准确无误。Iherebydeclarethattheabovestatementiscorrectandcompletetothebestofmyknowledgeandbelief.                                 申请人签名或盖章：                                                      Claimant(SignatureorSeal):           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。Certif

6、icateofResidentStatusofClaimant(FortheuseofresponsibletaxofficetheContractingStateinwhichtheclaimantisresident)orattachthespecialcertificateofresidentissuedbyresponsibletaxofficeoftheContractingStateinwhichtheclaimantisaresident.CertificationWecertifythat   (claimant’sname)isaresidentof   accor

7、dingtotheprovisionofparagraph   ,ofArticle   intheDoubleTaxationAgreementBetween          andthepeople’sRepublicofChina.(claimant’sname)isaresidentofaccordingtotheprovisionofparagraph,ofArticleintheDoubleTaxationAgreementBetweenan