《非居民享受税收协定待遇备案报告表》.docx

A04028《非居民享受税收协定待遇备案报告表》一、分类索引（一）业务类别税收优惠（二）表单类型纳税人填报（三）设置依据（表单来源）政策规定表单二、政策依据《国家税务总局关于〈非居民享受税收协定待遇管理办法（试行）〉有关问题的补充通知》（国税函〔2010〕290号）三、表单???????????????????? 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 name　2纳税人纳税识别号Taxpayers tax identification number　3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 China6境内邮政编码Postal code in China 　7纳税人境外地址Address in home country8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 Blank 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 ⑴　　　　　　　⑵　　　　　　　⑶　　　　　　　⑷　　　　　　　⑸　　　　　　　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 ⑴　　　　　　　⑵　　　　　　　⑶　　　　　　　⑷　　　　　　　⑸　　　　　　　26声　明 Declaration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 filled 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)