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

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1、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）ReportingFormforNon-residentTaxpayerClaimingTaxTreatyBenefits(FormAforIndividualIncomeTax)（享受税收协定股息、利息、特许权使用费条款待遇适用）(ApplicabletoTaxTreatyBenefitsunderArticlesofDividends,InterestorRoyalties)填表日期：年月日Fillingdate:YMD货币单位：元人民币Currencyunit:RMB〇自行申报〇扣缴申报〇退税Self-declarationWit

2、hholdingdeclaration Taxrefund一、扣缴义务人基本信息I.BasicInformationofWithholdingAgent扣缴义务人名称Nameofwithholdingagent　扣缴义务人纳税人识别号Taxidentificationnumberofwithholdingagent　二、非居民纳税人基本信息II.BasicInformationofNon-residentTaxpayer非居民纳税人中文名称Chinesenameo non-residenttaxpayer　非居民纳税人在居民国（地区）姓名Nameofnon-residenttaxpayeri

3、nresidentstate(region)　非居民纳税人身份证件类型TypeofIDcertificate　非居民纳税人身份证件号码NumberofIDcertificate　非居民纳税人享受税收协定名称Nameoftheapplicabletaxtreaty　所得类型Typeofincome○股息Dividends○利息Interest○特许权使用费Royalties三、扣缴义务人使用信息III.InformationforUsebyWithholdingAgent(一)享受股息条款待遇填写(I)ClaimingTaxTreatyBenefitsundertheArticleofDivi

4、dends1．非居民纳税人直接拥有支付股息的公司的股份比例Directsharehol ingpercentageofthenon-residenttaxpayerinthedividendpayingcompany　*2．非居民纳税人直接或间接拥有支付股息公司的股份比例合计Percentageoftotalsharecapitalheld,directlyandindirectly,bythenon-residenttaxpayerinthedividendpayingcompany　非居民纳税人在该公司的投资金额Amountofinvestmentinthedividendpayingc

5、ompanybythenon-residenttaxpayer金额：Amount:币种：Currency:（二）享受利息条款待遇填写(II)ClaimingTaxTreatyBenefitsundertheArticleofInterest*3．贷款资金是否存在以下情况Doanyofthefollowingcircumstancesapplyinrespectoftheloanedmonies?（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Theloanedmoniesareindirectlyprovidedbygovernmentorinstitutionoftheother

6、taxtreatycontractingpartyincircumstancesinwhichsuchindirectlyfinancedloansqualifyforbenefitsunderthetermsofthetreaty（2）□由税收协定缔约对方符合条件的政府或机构提供担保Aguaranteeisprovidedbyagovernmentorinstitutionoftheothertaxtreatycontractingpartyincircumstancesinwhichsuchguaranteedloansqualifyforbenefitsunderthetermsoft

7、hetreaty（3）□由税收协定缔约对方符合条件的政府或机构提供保险Insuranceisprovidedbyagovernmentorinstitutionoftheothertaxtreatycontractingpartyincircumstancesinwhichsuchinsuredloansqualifyforbenef tsunderthetermsofthetreaty*4．如贷款资金由税收