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1、附件 Annex 1非居民享受税收协定待遇备案报告表 Non-residents claim for treatment under Double Taxation Agreement (DTA) (for record)填报日期Date 年 月 日 Y/M/D1纳税人名称 Taxpayers name2纳税人纳税识别号 Taxpayers tax identification number3纳税人类型 Type of taxpayer企业 Enterprise个人 Individual4纳税人境内地址Address in China 5境内联系电话Telephone number in Ch
2、ina 6境内邮政编码Postal code in China 7纳税人境外地址Address in home country 8境外联系电话Telephone number in home country 9境外邮政编码Postal code in home country 10纳税人是否构成任何第三方税收居民Is the taxpayer a fiscal resident of a jurisdiction other than China & the other contracting party? 是 Yes否 No11如10栏选是，请列示第三方名称If yes is in Blan
3、k 10, please specify 12序号No. 13项目Item 14所得类型Type of income 15纳税方式Approach of tax payment16支付人或扣缴义务人名称Name of payer or withholding agent 17支付人或扣缴义务人纳税识别号Tax identification number of payer or withholding agent 18适用的税收协定及条款Applicable DTA and articles19是否属于关联交易An associated transaction or not 20收入额或应纳税所
4、得额Amount of gross income or taxable income 21减免税额Tax deduction or exemption 22备注Additional information 23符合享受税收协定待遇规定条件的理由Reasons for enjoying treatment under DTA 24本次备案附报资料清单List of documents attached to this form 25与本次备案有关但以前已提交的资料清单List of documents that have been submitted before 26声明 Declaratio
5、n 我谨声明以上呈报事项准确无误。I hereby declare that the above information is true and correct.纳税人印章或签字Stamp or signature of taxpayer： 年 月 日Y/M/D代理人印章或签字 Stamp or signature of attorney： 年 月 日Y/M/D27纳税人居民身份证明（由纳税人为其居民的缔约对方税务主管当局或其授权代表填写，或另附由该税务主管当局或其授权代表出具的专用证明） Applicants Certificate of Resident Status(to be fill
6、ed out by the competent authority or its authorized representative of the other contracting party of which the applicant is a resident, or a separate certificate issued by such authority or representative could be attached) CertificationWe hereby certify that (applicants name) is a resident of (name
7、 of the other contracting party) according to the provisions of Paragraph ,of Article in the (name of law). Stamp or signature of the competent authority or its authorized representative： Date(y/m/d) 28主管税务机关或其授权人印章或签字： Stamp or signature of the responsible tax office or its authorized representativ
8、e 年 月 日Y/M/D 填表说明：Note1.本表适用于需要享受备案类税收协定待遇的非居民。This form is required for non-residnets claiming for treatment under DTA by record.2.本表第10栏中“任何第三方税收居民”是指在任何第三方除仅因来源于该方的所得或坐落于该方的财产而在该方负有纳税义务外，还负有其他纳税义务的人。Fiscal resident in a jurisdiction other than China & the other contracting party in Blank 10 refer
9、s to a taxpayer that has tax payment obligations in that jurisdiction not only for income arising therefrom or for ownership of property situated therein.3.本表第13栏中项目按交易或合同名称填报。Fill in the name of the transaction or contract in Blank 13.4.本表第14栏中所得类型按所得类型代号填写，各所得类型代号为：营业利润；股息；利息；特许权使用费；财产收益；独立个人劳务所得；
10、非独立个人劳务所得；其他所得。各所得归类按适用的税收协定相应条款规定执行，但营业利润包括适用税收协定一般营业利润条款和表演家、运动员等特殊条款的营业利润；独立个人劳务所得包括适用税收协定一般独立个人劳务条款和表演家、运动员等特殊条款的独立个人劳务所得；非独立个人劳务所得包括适用税收协定一般非独立个人劳务条款和表演家、运动员等特殊条款的非独立个人劳务所得。Choose from the following codes for Blank 14 (Type of income):1.business profit; 2 dividend; 3 interest; 4 royalties; 5 ca
11、pital gains; 6 independent personal service income; 7 dependent personal service income; 8 other income. The income categorization is made in accordance with the applicable articles of DTA. Business profit includes the business profit stipulated both in the Business Profit Article and other articles such as Artistes and Sportsmen. Independent personal service income includes the service income stipulated both in the Independent Personal Services Arti
