附件5
非居民企業(yè)承包工程作業(yè)和提供勞務(wù)享受稅收協(xié)定待遇報(bào)告表
Non-resident Enterprises’ Claim for Treatment under Double Taxation Agreement
(Contracted construction and service projects)
編號(hào) Serial Number：
一、申請(qǐng)人事項(xiàng)Details of applicant:
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公司或團(tuán)體 Corporation or other entity |
名稱Name |
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總機(jī)構(gòu)所在地 Place of head office |
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郵政編碼 Postcode |
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實(shí)際管理機(jī)構(gòu)所在地 Place of effective management |
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郵政編碼 Postcode |
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注冊(cè)所在地 Place of registration |
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郵政編碼 Postcode |
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二、所得事項(xiàng)Details of income:
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承包工程 Contracted construction |
支付人名稱 Payer’s name |
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地址Address |
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郵編Postcode |
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合同名稱 Name of contract |
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合同字號(hào) Contract number |
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項(xiàng)目地點(diǎn) Place of project |
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項(xiàng)目持續(xù)時(shí)間 (年/月/日-年/月/日) Duration of project (y/m/d-y/m/d) |
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勞務(wù)人數(shù) Number of workers |
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支付金額及幣種 Amount of payment（unit） |
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支付日期 Date of payment |
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所得項(xiàng)目 Item of income |
□承包工程 □其他(請(qǐng)注明) Contracted construction Others（please specify） |
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納稅方式 Method of tax payment |
□指定扣繳 Designated withholding □自行申報(bào) Self-filing |
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提供勞務(wù) Performance of service
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支付人名稱 Payer’s name |
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地址Address |
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郵編Postcode |
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合同名稱 Name of contract |
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合同字號(hào) Contract number |
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勞務(wù)地點(diǎn) Place of service |
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勞務(wù)持續(xù)時(shí)間 (年/月/日-年/月/日) Duration of service (y/m/d-y/m/d) |
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勞務(wù)人數(shù) Number of workers |
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支付金額及幣種 Amount of payment（unit） |
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支付日期 (年/月/日) Date of payment (y/m/d) |
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勞務(wù)項(xiàng)目 Item of service |
□設(shè)計(jì)勞務(wù)Designing □咨詢勞務(wù)Consultancy □管理勞務(wù)Management □培訓(xùn)服務(wù)Training □技術(shù)服務(wù) Technical service □銷售設(shè)備同時(shí)提供勞務(wù) Providing service in connection with equipments sold □其它 (請(qǐng)注明) Others（please specify） |
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納稅方式 Method of tax payment |
□指定扣繳 Designated withholding □自行申報(bào) Self-filing |
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其他項(xiàng)目
Other items |
非居民名稱 Name |
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支付人名稱 Payer’s name |
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所得項(xiàng)目 Item of income |
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地址Address |
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郵編Postcode |
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支付金額及幣種 Amount of payment（unit） |
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支付日期（年/月/日） Date of payment (y/m/d) |
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三、申請(qǐng)適用避免雙重征稅協(xié)定 Application for Treatment under Double Taxation Agreement:
我謹(jǐn)在此申請(qǐng)依據(jù)中華人民共和國(guó)與 簽訂的避免雙重征稅協(xié)定第 條第 款，因承包工程作業(yè)或提供勞務(wù)項(xiàng)目不構(gòu)成在中國(guó)境內(nèi)設(shè)有常設(shè)機(jī)構(gòu)，享受不予征稅待遇。
I hereby apply to be non-liable for enterprise income tax as the contracted construction or service project does not constitute a permanent establishment in China in accordance with Paragraph , Article of the Tax Agreement between the People’s Republic of China and .
四、聲明 Declaration:
我謹(jǐn)在此聲明以上呈報(bào)事項(xiàng)準(zhǔn)確無(wú)誤。
I hereby declare that the above statement is correct and complete to the best of my knowledge and belief.
申請(qǐng)人（簽章）：
Applicant (Signature or seal):
五、申請(qǐng)人居民身份證明（由申請(qǐng)人為其居民的締約國(guó)主管稅務(wù)機(jī)關(guān)填寫, 或另附對(duì)方主管稅務(wù)機(jī)關(guān)出具的專用證明）。Applicant’s Certificate of Resident Status (To be filled out by the responsible tax office of the State in which the applicant is a resident, or to attach the certificate provided by the responsible tax office of the State in which the applicant is a resident).
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Certification We hereby certify that (applicant’s name) is a resident of (name of State) according to the provisions of Paragraph , of Article in the __________________ (name of law). Applicant’s serial number : Date (y/m/d) : Signature or stamp of tax office |
以下由中國(guó)主管稅務(wù)機(jī)關(guān)填寫（The following for the use of the responsible tax office of China only）:
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收到報(bào)告表日期(年/月/日) Date of receipt (y/m/d) |
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受理人（簽章） Receiver (signature) |
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備注 （Note）： |
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稅務(wù)機(jī)關(guān)（蓋章）
Stamp of Tax Office
注：本表一式兩份，一份退申請(qǐng)人，一份由稅務(wù)機(jī)關(guān)留存歸檔。
Note: This Form is in duplicate. The applicant and the tax authority concerned each has one copy.
