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Word文档下载推荐.docx
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元人民币
Currencyunit:
RMB
〇自行申报〇扣缴申报〇退税
Self-declarationWithholdingdeclaration
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-residenttaxpayerinresidentstate(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)ClaimingTaxTreatyBenefitsundertheArticleofDividends
1.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
Amountofinvestmentinthedividendpayingcompanybythenon-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
Theloanedmoniesareindirectlyprovidedbygovernmentorinstitutionoftheothertaxtreatycontractingpartyincircumstancesinwhichsuchindirectlyfinancedloansqualifyforbenefitsunderthetermsofthetreaty
(2)□由税收协定缔约对方符合条件的政府或机构提供担保
Aguaranteeisprovidedbyagovernmentorinstitutionoftheothertaxtreatycontractingpartyincircumstancesinwhichsuchguaranteedloansqualifyforbenefitsunderthetermsofthetreaty
(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.如贷款资金由税收协定缔约对方符合条件的政府或机构间接提供资金、担保或保险,请填写符合条件的政府或机构全称
Pleaseprovidethefullnameofthequalifiedgovernmentorinstitutionifloans/funds,aguaranteeorinsuranceareindirectlyprovidedbyaqualifiedgovernme
torinstitutionoftheothertaxtreatycontractingparty
(三)享受特许权使用费条款待遇填写
(III)ClaimingTaxTreatyBenefitsundertheArticleofRoyalties
5.据以产生该项特许权使用费的权利或财产属于以下哪种类型?
Towhichofthefollowingtypesofrightorpropertydotheroyaltiesfallinto?
(1)□文学、艺术或科学著作
Literature,artisticorscientificwork
(2)□专利、商标、设计、模型、图纸、秘密配方或秘密程序
Patent,trademark,design,model,plan,secretformulaorprocess
(3)□工业、商业、科学设备
Equipmentforindustrial,commercialorscientificuse
(4)□有关工业、商业、科学经验的信息
Informationconcerningindustrial,commercialandscientificexperience
(5)□其他特许权使用费
Otherroyalties
6.该所得是否属于飞机、船舶租赁所支付的特许权使用费?
Istheincomeattributableto
royaltypaidforaircraftleasingorshipchartering?
□是Yes
□否No
7.请简要描述据以产生特许权使用费所得的具体权利或财产。
Pleasegiveabriefdescriptionofthespecificrightorpropertyfromwhichtheroyaltyincomederives.
(四)其他信息
(IV)OtherInformation
8.该项所得是否与非居民纳税人设在中国的常设机构或固定基地有实际联系?
Istheincomeeffectivelyconnectedwithapermanentestablishmentorfixedbaseofthenon-residenttaxpayerinChina?
9.非居民纳税人是否通过代理人取得该项所得?
Didthenon-residenttaxpayerreceivetheincomeviaa
agent?
10.非居民纳税人为该项所得的“受益所有人”的声明
Declarationbynon-residenttaxpayerasthe"
beneficialowner"
oftheincome
提示:
“受益所有人”是指对所得或所得据以产生的权利或财产具有所有权和支配权的人。
如果非居民纳税人不是来源于中国的股息、利息或特许权使用费所得的受益所有人,则不能享受税收协定待遇。
Note:
A"
referstoapersonthatownsandhastherighttodisposeoftheincomeortherightsorpropertyfromwhichsuchincomederives.Anon-residenttaxpayerwhoisnotthebeneficialownerofthedividends,interestorroyaltiessourcedinChinaisnotentitledtothetaxtreatybenefits.
(1)非居民纳税人是否对所得或所得据以产生的财产或权利具有控制权或处置权?
Doesthenon-residenttaxpayerhavecontroloverortherighttodisposeoftheincomeorthepropertyorrightsfromwhichsuchincomederives?
(2)非居民纳税人是否对所得或所得据以产生的财产或权利承担相应风险?
D
esthenon-residenttaxpayerbeartherisksassociatedwiththeincomeorthepropertyorrightsfromwhichsuchincomederives?
(3)非居民纳税人据以取得该项所得的有关权利或财产是否为获得税收协定的减免税利益而安排?
Withrespecttothepropertyorrightsfromwhichthe
non-residenttaxpayerderivestheincome,havearrangementsbeenmadeinsucha