【表单说明】
一、本表适用于需享受我国对外签署的避免双重征税协定（含与港澳避免双重征税安排）或国际运输协定待遇的企业所得税非居民纳税人。
I. This form isapplicable to non-resident enterprise income taxpayer who claims tax benefitsunder a Double Taxation Agreement (DTA, including the DTAs with Hong Kong andMacau Special Administrative Regions) or International Transport Agreementsigned by China.
二、本表可用于自行申报或扣缴申报，也可用于非居民纳税人申请退税。非居民纳税人自行申报享受协定待遇或申请退税的，应填写本表一式两份，一份在申报享受协定待遇或申请退税时交主管税务机关，一份由非居民纳税人留存；对非居民纳税人来源于中国的所得实施源泉扣缴或指定扣缴管理的，非居民纳税人如需享受协定待遇，应填写本表一式三份，一份交由扣缴义务人在扣缴申报时交主管税务机关，一份由扣缴义务人留存备查，一份由非居民纳税人留存。
II. This form can beused for self-declaration or withholding declaration, as well as for thenon-resident taxpayer’s application for tax refund. The non-resident taxpayerinitiating the self-declaration for claiming tax treaty benefits, or applyingfor tax refund, shall complete two copies of the form: one form is to besubmitted to the in-charge tax authority at the time of such declaration orapplication, and the other form is to be kept by the non-resident taxpayer.Where the non-resident taxpayer’s China sourced income is subject towithholding tax, administered at source or by means of a designated withholdingagent, and the non-resident taxpayer is entitled to tax treaty benefits, thenon-resident taxpayer shall complete three copies of the form: one is to begiven to the withholding agent to submit to the in-charge tax authority at thetime of the withholding declaration, one is to be kept by the withholding agentand another is to be kept by the non-resident taxpayer.
三、本表第一部分由扣缴义务人填写，如非居民纳税人自行申报纳税则无需填写。本表其余部分由非居民纳税人填写。非居民纳税人填报本表时可根据需要增加附页。
III. Part I of theform shall be filled in by the withholding agent, and will not be required inthe case of self-declaration. The rest of the form shall be filled in by thenon-resident taxpayer. When filling in the form, the non-resident taxpayer canattach separate sheets to the form if necessary.
四、本表第三部分“扣缴义务人使用信息”用于在源泉扣缴或指定扣缴情况下，扣缴义务人核对非居民纳税人是否符合享受协定待遇条件；其他部分用于税务机关采集管理信息。
IV. “Information foruse by withholding agent” in Part III of the form is used by a withholdingagent to decide if a non-resident taxpayer is eligible for tax treaty benefitsin withholding at source; the rest is for the tax authority to gatherinformation for administrative purposes.
五、非居民纳税人应如实完整填写本表所列问题。如非居民纳税人没有问题所列情况，请在表格中填“无”。本表所列选择题，请非居民纳税人在符合自身情况的选项对应的□或○中打勾“√”。带有*标识的题目，请具有题目所描述情况的非居民纳税人填写，与题目所描述情况不符的非居民纳税人无需填写。
V. The non-residenttaxpayer shall provide accurate and complete information to answer thequestions contained in the form. Please write “N/A” in the form if a situationdescribed in a question is not applicable for a non-resident taxpayer. For a multiple-choice question, please mark “√” in a corresponding box (“□”) or circle (“○”) for a choice that fits anon-resident taxpayer’s situation. If a non-resident taxpayer’s situation falls into the description of a question marked with “*”, answers shall be provided;otherwise, it can be skipped.
六、本表采用中英文双语制作，如中英文表述不一致，以中文为准。如无特别说明，应使用中文填写。
VI. This form isprepared in Chinese and English. In case of divergence in the two languages,the Chinese text shall prevail. Unless otherwise stated, it shall be completedin Chinese.
七、本表各栏填写如下：
VII. Instructions onhow to fill in each item are as follows:
（一）扣缴义务人基本信息
（I）Basic Information of Withholding Agent
1.扣缴义务人名称：由扣缴义务人填写税务登记证所载扣缴义务人的全称。
Name of withholdingagent: The withholding agent should provide its full name as shown in its taxregistration certificate.
2.扣缴义务人纳税人识别号：由扣缴义务人填写扣缴义务人税务登记证上注明的“纳税人识别号”。
Tax identification number of withholdingagent: The withholding agent should provide its identification number as shownin the tax registration certificate.
（二）非居民纳税人基本信息
（II）Basic Information of Non-resident Taxpayer
3.非居民纳税人中文名称：填写非居民纳税人在中国境内的中文全称。
Chinese name ofnon-resident taxpayer: Fill in the full Chinese name used by the non-residenttaxpayer in China.
4.非居民纳税人在居民国（地区）名称：填写非居民纳税人在其居民国（地区）的英文全称。
Name of non-residenttaxpayer in resident state (region): Fill in the full English name of thenon-resident taxpayer which is used in the non-resident taxpayer’s state(region) of residence.
5.非居民纳税人的居民国（地区）：填写非居民纳税人为其税收居民的独立税收管辖区的名称。如果非居民纳税人是香港、澳门税收居民，请填写“香港特别行政区”或“澳门特别行政区”。
Resident state(region): Fill in the name of the independent tax jurisdiction where thenon-resident taxpayer is a resident. Tax resident of Hong Kong or Macau SARs should indicate "Hong Kong SAR" or"Macau SAR" as appropriate.
（三）扣缴义务人使用信息
（III）Information for Use by Withholding Agent
6.问题1，非居民纳税人在缔约对方的组织类型：“具有独立纳税地位的营利实体”和“不具有独立纳税地位的营利实体”，按非居民纳税人是否在缔约对方单独缴纳属于协定适用范围的所得税判定。组织类型选择“其他”的，须填写问题2，简要说明非居民纳税人的组织类型、具体特征和性质。
Question 1, “Theorganization type of the non-resident taxpayer in the other contracting party”:Determine if the non-resident taxpayer is a "business entity withindependent taxpayer status" or a "business entity without independenttaxpayer status" based on whether it independently pays the taxes coveredby the Agreement in the other contracting party. Answer Question 2 if theorganization type is categorized as "Others". Briefly describe theorganization type, characteristics and nature of the non-resident taxpayer.
7.问题3，请引述非居民纳税人构成缔约对方税收居民的缔约对方国内法律依据：填写缔约对方国家（或地区）如何定义和判定其税收居民的国内法律条文。请写明法律条文所属法律法规名称和条款序号，并引述相关法律条文。
Question 3, “Pleasecite the domestic legal basis based on which the non-resident taxpayerqualifies as a tax resident of the other contracting party”: Cite theprovisions of the domestic law of the other contracting state (region) on howto define and determine tax residency. Specify the name of the law, the numberof the relevant clauses, and specific provisions.
8.问题4，请简要说明非居民纳税人构成缔约对方税收居民的事实情况：在此栏中填写非居民纳税人符合需享受协定的缔约对方国家（或地区）国内构成税收居民的法律标准的具体事实。例如缔约对方国内法采取注册地标准判定税收居民的，非居民纳税人应说明企业注册地、注册时间等注册情况。
Question 4, “Pleasebriefly describe the facts based on which the non-resident taxpayer qualifiesas a tax resident of the other contracting party”: Provide facts in support ofthe claim that the non-resident taxpayer qualifies as a tax resident of theother contracting state (region). For example, where the contracting partydetermines tax residency based on the place of registration, the non-residenttaxpayer should provide information such as the place and time of registration,etc.
9.问题5，声明：由非居民纳税人的法定代表人或其授权代表负责人签字并/或加盖企业公章，并填写签字当日日期。
Question 5,“Declaration”: Declaration should be signed and dated by the legal representativeor the designated person of the non-resident taxpayer, and/or sealed by thenon-resident taxpayer.
（四）税务机关管理使用信息
(IV) Information forUse by Tax Authorities
10.问题7，非居民纳税人注册地（国家或地区）：填写非居民纳税人注册登记的独立税收管辖区名称。如非居民纳税人在香港、澳门注册登记，应填写“香港特别行政区”或“澳门特别行政区”。非居民纳税人实际管理机构所在地（国家或地区）、非居民纳税人总机构所在地（国家或地区），也应填写相关独立税收管辖区名称。
Question 7, “Place ofregistration (state or region)”: State the name of the independent taxjurisdiction where the non-resident taxpayer is registered. If registered in Hong Kong or Macau SAR, note "Hong Kong SAR" or"Macau SAR" as appropriate. It is the same in case of the place ofeffecitve management and the place of head office.
11.问题9，享受税收协定股息、利息、特许权使用费、财产收益条款税收协定待遇的非居民纳税人，请填写直接或间接持有本企业权益额达到10%以上的股东情况：根据非居民纳税人申报享受税收协定待遇时的股东情况填写。
Question 9, “For anon-resident enterprise claiming for the benefits under the Agreement'sarticles of dividends, interest, royalties or capital gains, please provideinformation of all shareholders holding directly or indirectly at least 10 percent of rights and interests of theenterprise”: Provide the latest information at the time of claiming fortreatment under the Agreement.
12.问题10，非居民纳税人从中国取得的所得在居民国（地区）的纳税情况：法定税率根据居民国（地区）国内法的规定填写。如非居民纳税人享受了居民国（地区）国内减免税优惠，请写明非居民纳税人所享受减免税优惠的法律条文所属法律法规名称和条款序号，并引述相关法律条文。如非居民纳税人未享受居民国（地区）国内减免税优惠，在“享受居民国（地区）国内减免税优惠的法律依据及条文描述”栏填“无”。
Question 10,“Information of taxes paid in the resident state (or region) on the incomederived from China”:Specify the statutory tax rate as prescribed in the domestic law of theresident state (region). If the non-resident taxpayer has enjoyed tax reductionor exemption in the resident state (region), quote the name of the relevantlaw, the number of relevant clauses, and specific provisions that form thebasis for such reduction or exemption. Note "N/A" if the non-residenttaxpayer did not enjoy any reduction or exemption in the resident state(region).
13.问题11，根据第三国（地区）法律规定，非居民纳税人同时还构成哪些国家（地区）的税收居民：如果依据中国和非居民纳税人需享受协定缔约对方国家（地区）之外的第三国（地区）法律规定，非居民纳税人同时构成该第三国（地区）的税收居民，请写明该第三国（地区）名称，如涉及多个国家或地区的，请全部列明。
Question 11, “Does thenon-resident taxpayer qualify as a tax resident of other states (regions) basedon the laws of such states (regions)”: If the taxpayer qualifies as a taxresident of a third state (region) other than China or the other contractingparty based on the laws of that third state (region), specify the name of thatstate (region). If more than one states (regions) are relevant, please specifyall of them.
（五）备注
(V) Additional Notes
14.可填写非居民纳税人认为主管税务机关需要了解的其他有助于核查其居民身份的信息。如非居民纳税人有特殊情况，也请在备注中注明。
Non-resident taxpayercan provide other information that the non-resident taxpayer believes should beconsidered by the in-charge tax authority about the non-resident taxpayer’sresidence status. Please specify the special situations in the additionalnotes, if any.
（六）声明
(VI) Declaration
15.由非居民纳税人的法定代表人或其授权代表负责人签字并/或加盖企业公章，并填写声明日期。
The declaration shallbe sealed by the non-resident taxpayer, and/or signed by the legal representative or authorized representativeof the non-resident enterprise, and the date of the statement shall beprovided.
八、中国税务机关将对非居民纳税人提交的信息资料保密。
VIII. Any information and materials provided by the non-residenttaxpayer will be kept confidential by China’s tax authorities.
