外籍居民个人储蓄存款利息所得享受避免双重征税协定待遇申请表

外籍居民个人储蓄存款利息所得享受避免双重征税协定待遇申请表

Application for Tax Agreement Treatment with Respect to

Depository Interest Rcceived by Foreign Resident Individuals

　　XX  税务局　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 To 　　　　　　　　　　 Tax office

一、申请人事项（Detals of Claimant）：　 　　　　　　　　　 申请日期（Date for application:y/m/d）： 2XXX年XX月XX日　　　　　　　

二、所得事项（Details of income）

三、个人在中华人民共和国境内的开户银行(Information of the bank in which the applicant opens on account)

银行名称（Name of the bank）：　 　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 

地址(Address)：　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　

四、适用的税收协定（Tax agreement applicable）

中华人民共和国同　　　　　　　国签订的避免双重征税协定第　　　　　 条第　　　　　　 款。

Paragraph　　　　　 Article　　　　　of the Tax Agreement between the People’s Republic of China and　　　　　　　　　　.

五、其他事项（others）：　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 　　　　　　　　　　　　　　　 

我谨在此声明以上呈报事项准确无误。

I hereby declare that the above statement is correct and complete to the best of my knowledge and belief.

申请人签名或盖章：　　　　　　　　

Claimant’s signature or seal: 　　　　　　　 

六、申请居民身份证明（由申请人为其居民的缔约国主管税务机关填写）

Certificate of resident status of claimant (To be filled by the competent authority of the resident of the claimant)

以下由主管税务机关填写（To be filled out by the competent tax office）

主管税务机关盖章（Stamp by the competent tax office）

关于填写《外籍居民个人储蓄存款利息所得享受避免双重征税协定待遇申请表》的说明

一、填报范围和程序

（一）本表适用于中华人民共和国签订避免双重征税协定（以下简称“税收协定”）国家的居民个人，就取得来源于中国的储蓄存款利息所得申请享受税收协定待遇时填报。

（二）本表由存款利息所得人向主管税务机关索取并填写，经当地主管税务机关审核认可后据以执行。

二、本表填写说明

（一）申请人事项

“个人住所或居所”填写申请人在税收上为其居民国家的住所或居所地址及邮政编码。

（二）其它事项

申请人填写对表列各项或其他需要说明的事项。

（三）该表末项所列“主管税务机关盖章”是指主管申请人提出该项税收业务的中国县（市）级税务机关或辖属对外分局，并应加盖本机关公章。

Instructions for Filling out the Application for Tax Agreement Treatment with Respect to

Depository Interest Received by Foreign Resident Individuals

Ⅰ.Applicable scope and procedure for filling our the form

1.1 This Application is applicable to residents of the countries that have concluded the Agreement for the Avoidance of Double Taxation (hereinafter referred to as the “Tax Agreement”) with the People’s Republic of China who claim for tax agreement treatment with respect to depository interest derived in China.

1.2 This form is to be obtained from the competent tax office and completed by the recipient of depository interest. It enters into force consequent to the verification by and upon approval from the competent tax office.

Ⅱ.Explanations for the items in the Application

2.1 “Details of claimant”: “Domicile or residence” indicates the address of the claimant’s domicile or residence and the postcode of the place where the claimant is a resident and qualifies for tax purpose.

2.2 “Other”: meaning notes necessary by the claimant on the items listed in the Application or other additional but necessary remarks.

2.3 “Stamp by the competent tax office” at the end of the Application means the official stamp by the tax administration at or above the country or city level or by the affiliated branch there of that is in charge of the tax affairs in the jurisdiction in which the applicant’s tax liability occurs.