非居民納稅人享受稅收協(xié)定待遇情況報(bào)告表(企業(yè)所得稅A表)

非居民納稅人享受稅收協(xié)定待遇情況報(bào)告表（企業(yè)所得稅A表）
Reporting Form for Non-resident Taxpayer Claiming Tax Treaty Benefits
(Form A for Enterprise Income Tax)

（享受稅收協(xié)定股息、利息、特許權(quán)使用費(fèi)條款待遇適用）
(Applicable to Tax Treaty Benefits under Articles of Dividends, Interest or Royalties)

填表日期：      年   月   日
Filling date:        Y    M    D      

貨幣單位：元人民幣
Currency unit: RMB

     ○ 自行申報(bào)                  ○ 扣繳申報(bào)                               ○ 退稅
         Self-declaration                Withholding declaration                Tax refund

一、扣繳義務(wù)人基本信息
I. Basic Information of Withholding Agent

扣繳義務(wù)人名稱
Name of withholding agent

扣繳義務(wù)人納稅人識(shí)別號(hào)
Tax identification number of withholding agent

二、非居民納稅人基本信息
II. Basic Information of Non-resident Taxpayer

非居民納稅人中文名稱
Chinese name of non-resident taxpayer

非居民納稅人在中國的納稅人識(shí)別號(hào)
Tax identification number of non-resident taxpayer in China

非居民納稅人在居民國（地區(qū)）的名稱
Name of non-resident taxpayer in resident state (region)

非居民納稅人在居民國（地區(qū)）納稅人識(shí)別號(hào)
Tax identification number of non-resident taxpayer in resident state (region)

非居民納稅人享受稅收協(xié)定名稱
Name of the applicable tax treaty

所得類型
Type of income

○ 股息 Dividends            ○ 利息 Interest         ○ 特許權(quán)使用費(fèi) Royalties

三、扣繳義務(wù)人使用信息III. Information for Use by Withholding Agent

（一）享受股息條款待遇
  (I) Claiming Tax Treaty Benefits under the Article of Dividends

1．非居民納稅人類型
    Type of non-resident taxpayer
  （1）□政府、政府機(jī)構(gòu) 
               Government or governmental body
  （2）□稅收協(xié)定締約對(duì)方政府直接或間接擁有至少20%股份的締約對(duì)方居民公司 
               Resident company of the other tax treaty contracting party with no less than 20% of its shares held by the government of the other contracting party, whether directly or indirectly
  （3）□稅收協(xié)定締約對(duì)方政府直接或間接全部擁有資本的其他實(shí)體 
                Other entity with all its capital held by the government of the other tax treaty contracting party, whether directly or indirectly
  （4）□其他公司 
               Other companies
  （5）□合伙企業(yè) 
               Partnership enterprises
  （6）□其他組織類型                  請(qǐng)說明 Please specify：_____________________________________________
               Other types of entity   

2．非居民納稅人直接擁有支付股息的公司的股份比例
    Direct shareholding percentage of the non-resident taxpayer in the dividend paying company

3．非居民納稅人直接擁有股份比例在取得股息前的12個(gè)月內(nèi)是否曾有低于25%（不含25%）的情況？
    Has the direct shareholding percentage of the non-resident taxpayer in the dividend paying company been less than 25% (excluding 25%) at any time during the 12 months prior to the declaration of the dividends?

  □  是  Yes
  □  否   No

*4．非居民納稅人直接或間接擁有支付股息公司的股份比例合計(jì)    
    Percentage of total share capital held, directly and indirectly, by the non-resident taxpayer in the dividend paying company

    非居民納稅人在該公司的投資金額
    Amount of investment in the dividend paying company by the non-resident taxpayer

金額：
Amount:

幣種：
Currency:

（二）享受利息條款待遇
  (II) Claiming Tax Treaty Benefits under the Article of Interest

5．非居民納稅人是否是稅收協(xié)定列明利息所得免稅組織或機(jī)構(gòu)？
    Is the non-resident taxpayer listed as an organization or institution specifically exempt from source country tax on interest in the tax treaty?

  □  是  Yes
  □  否   No

6．非居民納稅人類型
    Type of non-resident taxpayer
  （1）□稅收協(xié)定締約對(duì)方的政府、行政區(qū)、地方當(dāng)局 
                Government, political subdivision, local authority of the other tax treaty contracting party
  （2）□稅收協(xié)定締約對(duì)方中央銀行 
               Central Bank of the other tax treaty contracting party
  （3）□銀行 
               Bank
  （4）□其他金融機(jī)構(gòu) 
               Other financial institution
  （5）□其他企業(yè)或組織
              Other business or organization

7．非居民納稅人是否完全為稅收協(xié)定締約對(duì)方的政府所有？    Is the non-resident taxpayer wholly-owned by the government of the other tax treaty contracting party?

   □  是  Yes   □  否  No

*8．貸款資金是否存在以下情況
    Do any of the following circumstances apply in respect of the loaned monies?
   （1）□由稅收協(xié)定締約對(duì)方符合條件的政府或機(jī)構(gòu)間接提供資金
                The loaned monies are indirectly provided by government or institution of the other tax treaty contracting party in circumstances in which such indirectly financed loans qualify for benefits under the terms of the treaty
   （2）□由稅收協(xié)定締約對(duì)方符合條件的政府或機(jī)構(gòu)提供擔(dān)保
                A guarantee is provided by a government or institution of the other tax treaty contracting party  in circumstances in which such guaranteed loans qualify for benefits under the terms of the treaty
   （3）□由稅收協(xié)定締約對(duì)方符合條件的政府或機(jī)構(gòu)提供保險(xiǎn)
                Insurance is provided by a government or institution of the other tax treaty contracting party  in circumstances in which such insured loans qualify for benefits under the terms of the treaty

*9．如貸款資金由稅收協(xié)定締約對(duì)方符合條件的政府或機(jī)構(gòu)間接提供資金或擔(dān)?；虮ｋU(xiǎn)，請(qǐng)?zhí)顚懛蠗l件的政府或機(jī)構(gòu)全稱
    Please provide the full name of the qualified government or institution if loans/funds, a guarantee or insurance are indirectly provided by a qualified government or institution of the other tax treaty contracting party

（三）享受特許權(quán)使用費(fèi)條款待遇
 (III) Claiming Tax Treaty Benefits under the Article of Royalties

10．據(jù)以產(chǎn)生該項(xiàng)特許權(quán)使用費(fèi)的權(quán)利或財(cái)產(chǎn)屬于以下哪種類型？
    To which of the following types of right or property do the royalties fall into?
  （1）□文學(xué)、藝術(shù)或科學(xué)著作
                 Literature, artistic or scientific work
  （2）□專利、商標(biāo)、設(shè)計(jì)、模型、圖紙、秘密配方或秘密程序
                 Patent, trade mark, design, model, plan, secret formula or process
  （3）□工業(yè)、商業(yè)、科學(xué)設(shè)備
                 Equipment for industrial, commercial or scientific use
  （4）□有關(guān)工業(yè)、商業(yè)、科學(xué)經(jīng)驗(yàn)的信息
                 Information concerning industrial, commercial and scientific experience
  （5）□其他特許權(quán)使用費(fèi) 
                 Other royalties

11．該所得是否屬于飛機(jī)、船舶租賃所支付的特許權(quán)使用費(fèi)？
    Is the income attributable to a royalty paid for aircraft leasing or ship chartering?  

   □ 是  Yes
   □ 否  No

12．請(qǐng)簡要描述據(jù)以產(chǎn)生特許權(quán)使用費(fèi)所得的具體權(quán)利或財(cái)產(chǎn)。
    Please give a brief description of the specific right or property from which the royalty income derives.

（四）其他信息  (IV) Other Information

13．該項(xiàng)所得是否與非居民納稅人設(shè)在中國的常設(shè)機(jī)構(gòu)或固定基地有實(shí)際聯(lián)系？
    Is the income effectively connected with a permanent establishment or fixed base of the non-resident taxpayer in China?

   □ 是  Yes
   □ 否  No

14．非居民納稅人是否通過代理人取得該項(xiàng)所得？
    Did the non-resident taxpayer receive the income via an agent?

   □ 是  Yes
   □ 否  No

15．非居民納稅人為該項(xiàng)所得的“受益所有人”的聲明
    Statement by non-resident taxpayer as the "beneficial owner" of the income

    提示：“受益所有人”是指對(duì)所得或所得據(jù)以產(chǎn)生的權(quán)利或財(cái)產(chǎn)具有所有權(quán)和支配權(quán)的人。如果非居民納稅人不是來源于中國的股息、利息或特許權(quán)使用費(fèi)所得的受益所有人，則不能享受稅收協(xié)定待遇。
    Note: A "beneficial owner" refers to a person that owns and has the right to dispose of the income or the rights or property from which such income derives. A non-resident taxpayer who is not the beneficial owner of the dividends, interest or royalties sourced in China is not entitled to the tax treaty benefits.

（1）非居民納稅人是否對(duì)所得或所得據(jù)以產(chǎn)生的財(cái)產(chǎn)或權(quán)利具有控制權(quán)或處置權(quán)？
        Does the non-resident taxpayer have control over or the right to dispose of the income or the property or rights from which such income derives?

   □ 是  Yes
   □ 否  No

（2）非居民納稅人是否對(duì)所得或所得據(jù)以產(chǎn)生的財(cái)產(chǎn)或權(quán)利承擔(dān)相應(yīng)風(fēng)險(xiǎn)？
        Does the non-resident taxpayer bear the risks associated with the income or the property or rights from which such income derives?

   □ 是  Yes
   □ 否  No

（3）非居民納稅人據(jù)以取得該項(xiàng)所得的有關(guān)權(quán)利或財(cái)產(chǎn)是否為獲得稅收協(xié)定的減免稅利益而安排？
        With respect to the property or rights from which the non-resident taxpayer derives the income, have arrangements been made in such a way so as to gain access to the treaty benefits of tax exemption or reduction?

   □ 是  Yes
   □ 否  No

（4）聲明：
        Declaration:

    我謹(jǐn)聲明，我為該項(xiàng)所得的受益所有人，我取得該項(xiàng)所得的有關(guān)權(quán)利并非為了獲得稅收協(xié)定利益而安排。
     I hereby declare that I am the beneficial owner of the income, and arrangements have not been made, with repect to the rights from which the income derives, for the purpose of gaining tax treaty benefits.


                                 非居民納稅人簽章或簽字                                                      年          月          日
                                 Seal or signature of non-resident taxpayer                                  Y           M            D

16．享受稅收協(xié)定待遇的優(yōu)惠稅率（或?qū)嶋H征收率）
    Preferential tax rate under tax treaty treatment (or actual tax rate)

四、稅務(wù)機(jī)關(guān)管理采集信息IV. Information for Use by Tax Authorities

（一）享受股息條款待遇
  (I) Claiming Tax Treaty Benefits under the Article of Dividends

*17．非居民納稅人是否為稅收協(xié)定締約對(duì)方的上市公司？
    Is non-resident taxpayer a listed company in the other tax treaty contracting party?

  □ 是 請(qǐng)?zhí)顚憜栴}19
      Yes. Please answer Question 19
  □ 否  No

*18．非居民納稅人是否為稅收協(xié)定締約對(duì)方居民且在締約對(duì)方上市的公司100%直接或間接擁有（不含通過不屬于中國居民或締約對(duì)方居民的第三方國家或地區(qū)居民企業(yè)間接持有股份的情況）？
    Is the non-resident taxpayer held 100%, directly or indirectly, by a resident of the other tax treaty contracting party, which is a listed company in the other tax treaty contracting party as well (indirect shareholdings by residents of a third state or region, other than residents of China or the other tax treaty contracting party, is excluded )?

  □ 是 請(qǐng)?zhí)顚憜栴}19
      Yes. Please answer Question 19
  □ 否  No

*19．上市證券交易所名稱
Name of the stock exchange

上市股票代碼
Stock code

（二）享受利息條款待遇
  (II) Claiming Tax Treaty Benefits under the Article of Interest

20．貸款合同利率
    Interest rate for loan contract                                                                                 

    同期市場(chǎng)利率
    Market interest rate of the same period

    還款條件
    Repayment terms

21．非居民納稅人與利息支付人之間是否有關(guān)聯(lián)關(guān)系？
    Is there any related party relationship between non-resident taxpayer and interest payer?

   □ 是  Yes
   □ 否  No

22．在利息據(jù)以產(chǎn)生和支付的貸款合同之外，非居民納稅人與第三人之間是否存在在數(shù)額、利率和簽訂時(shí)間等方面相近的其他貸款或存款合同?
    Apart from the loan agreement in respect of which interest arises and is paid, are there any other loan or deposit contracts between the non-resident taxpayer and a third party which are similar in terms of the amount, interest rate, date of signing and other aspects?  

  □  是 請(qǐng)?jiān)谙乱活}中說明 
        Yes. Please specify in the next question
  □  否 No

*23．請(qǐng)簡要說明非居民納稅人與第三人之間合同情況（包括第三人名稱、第三人與非居民納稅人的關(guān)系、合同簽約日期、金額、期限、利率、付息與還款條件、擔(dān)保人等）
    Please give a brief account of the contract(s) entered into between the non-resident taxpayer and the third party (including the name of the third party, the relationship between the non-resident taxpayer and the third party, date of contract signing, contract amount, contract period, interest rate, interest and principal repayment terms, guarantor, etc.).

（三）享受特許權(quán)使用費(fèi)條款待遇   (III) Claiming Tax Treaty Benefits under the Article of Royalties

24．對(duì)據(jù)以產(chǎn)生特許權(quán)使用費(fèi)的權(quán)利或財(cái)產(chǎn)，非居民納稅人是否擁有權(quán)屬證明?如有，可另附權(quán)屬證明材料。
    Does the non-resident taxpayer have an ownership certificate with respect to the rights or property from which the royalties derive? If so, the copy of the certificate may be attached separately.

   □ 是  Yes
   □ 否  No

25．非居民納稅人與特許權(quán)使用費(fèi)支付人之間是否有關(guān)聯(lián)關(guān)系？
    Is there a related party relationship between non-resident taxpayer and royalty payer?

   □ 是  Yes
   □ 否  No

26．在特許權(quán)使用費(fèi)據(jù)以產(chǎn)生和支付的版權(quán)、專利、技術(shù)等使用權(quán)轉(zhuǎn)讓合同之外，非居民納稅人與第三人之間是否存在在有關(guān)版權(quán)、專利、技術(shù)的使用權(quán)或所有權(quán)方面的轉(zhuǎn)讓合同？
    Apart from transfer agreement under which the right to use copyright, patent, technology or other rights arises and under which the royalty is paid, are there any other transfer agreements, between the non-resident taxpayer and a third party, concerning the right to use or ownship of  related copyright, patent, technology or other rights?  

  □ 是 請(qǐng)?jiān)谙乱活}中說明 
       Yes.   Please specify in the next question
  □ 否 No

*27．請(qǐng)簡要說明非居民納稅人與第三人之間合同情況（包括第三人名稱、第三人與非居民納稅人的關(guān)系、合同簽約日期、金額、期限、受讓使用條件、收費(fèi)方式等）
    Please give a brief account of the contract(s) entered into between the non-resident taxpayer and the third party (including the name of the third party, the relationship between the non-resident taxpayer and the third party, date of contract signing, contract amount, contract period, conditions of use by licensee, manner in which fees are to be paid, etc.).

*28．如果非居民納稅人因轉(zhuǎn)讓或許可專有技術(shù)使用權(quán)而取得特許權(quán)使用費(fèi)，請(qǐng)回答下列問題
     Where the non-resident taxpayer has transferred or licensed the right to use know-how and derives royalties therefrom, please answer the following questions

（1）非居民納稅人是否派人員為該項(xiàng)技術(shù)的使用提供有關(guān)支持、指導(dǎo)等服務(wù)并收取服務(wù)費(fèi)？
         Does the non-resident taxpayer send employees to provide assistance, guidance or other services related to the use of the know-how, and charge a service fee for this?

  □ 是  請(qǐng)回答下面兩個(gè)問題
       Yes.  Please answer the following two questions
  □ 否  No

（2）非居民納稅人派遣人員在中國為該項(xiàng)技術(shù)的使用提供有關(guān)支持、指導(dǎo)等服務(wù)連續(xù)或累計(jì)持續(xù)的時(shí)間（月數(shù)或天數(shù)）
         Please state the cumulative time which the dispatched employees spend in China, on a continuous or successive basis, in rendering the assistance, guidance or other services related to the use of the know-how (months or days basis)

（3）非居民納稅人派人員為該項(xiàng)技術(shù)的使用提供有關(guān)支持、指導(dǎo)等服務(wù)是否已構(gòu)成設(shè)在中國的常設(shè)機(jī)構(gòu)？
        Does the non-resident taxpayer, by sending employees to China to render the assistance, guidance or other services related to the use of the know-how, give rise to a permanent establishment?

   □ 是  Yes
   □ 否  No

（四）其他信息  (IV) Other Information

29．請(qǐng)簡要說明除持有該項(xiàng)所得據(jù)以產(chǎn)生的權(quán)利或財(cái)產(chǎn)外，非居民納稅人的其他經(jīng)營活動(dòng)情況和其他財(cái)產(chǎn)情況
    Please give a brief account of operating activities and assets of the non-resident taxpayer, other than the rights or property from which the income derives.

30．非居民納稅人上一會(huì)計(jì)年度財(cái)務(wù)情況
    Financial position of the previous fiscal year of the non-resident taxpayer

注冊(cè)資本：
Registered capital:

管理費(fèi)用金額：
General and administrative expenses:

董事費(fèi)金額：
Directors' fees:

工資薪金總額：
Sum of employees' wages and salaries:

31．非居民納稅人最近一次舉行董事會(huì)情況
    Information on the non-resident taxpayer's most recent board meeting

時(shí)間：
Time:

地點(diǎn)：
Location:

32．非居民納稅人是否有義務(wù)在收到所得的12個(gè)月內(nèi)將所得的全部或絕大部分（60%以上）支付或派發(fā)給第三國（地區(qū)）居民?
     Is the non-resident taxpayer obligated to pay or distribute all or most of (above 60% of) the income to residents of a third state (region) within 12 months after the receipt of the income?

 □ 是  請(qǐng)?zhí)顚懴旅?/span>2個(gè)問題
      Yes.  Please fill in the following two questions
  □ 否 No

*33．非居民納稅人在取得該項(xiàng)所得后的12個(gè)月內(nèi)有義務(wù)對(duì)外支付或派發(fā)的情況
    Non-resident taxpayer is obligated to pay or distribute the income within 12 months after receipt

收款方名稱
Name of recipient

收款方居民國（地區(qū)）
Resident state (region) of recipient

支付比例
Payment percentage

支付時(shí)間
Time of payment

*34．請(qǐng)簡要說明對(duì)該項(xiàng)所得進(jìn)行上述處理的理由
    Please briefly account for the above treatment of the income.

35．締約對(duì)方國家（地區(qū)）對(duì)此項(xiàng)所得的稅務(wù)處理情況    Tax treatment of the income in the other contracting party      □不征稅                      □免稅                     □征稅稅率小于等于12.5%                         □其他        Not liable to tax             Exempt                    Tax rate less than or equal to 12.5%           Others

*36．如果非居民納稅人通過代理人取得該項(xiàng)所得，請(qǐng)?zhí)顚懸韵聠栴}
    If the non-resident taxpayer receives the income through an agent, please fill in the following questions

  （1）代理人名稱
           Name of the agent

  （2）代理人收費(fèi)標(biāo)準(zhǔn)和條件
           Standard service charge and terms of agency relationship

  （3）與代理相關(guān)的風(fēng)險(xiǎn)和收益是否由非居民納稅人承擔(dān)？
           Does the non-resident taxpayer assume the risks and enjoy the benefits in relation to the assets held and income passing via the agent?

   □ 是  Yes
   □ 否  No

  （4）請(qǐng)簡要說明代理關(guān)系雙方的權(quán)利和義務(wù)。
           Please give a brief account of the right and obligations of both parties in the agency relationship.

37．非居民納稅人近三年是否有來源于中國境內(nèi)其他地區(qū)的同類所得？
    Has the non-resident taxpayer received any income of the same type sourced in other regions within China over the past three years?

   □ 是  Yes
   □ 否  No

*38．非居民納稅人近三年是否就來源于中國境內(nèi)其他地區(qū)的同類所得享受過稅收協(xié)定待遇？ 
    Has the non-resident taxpayer claimed tax treaty benefits for the income of the same type sourced in other regions within China over the past three years?

   □ 是  Yes
   □ 否  No

*39．請(qǐng)說明非居民納稅人近三年就來源于中國境內(nèi)其他地區(qū)的同類所得享受稅收協(xié)定待遇的情況
    Please indicate the details of any tax treaty benefits claimed by the non-resident taxpayer for the same type of income sourced in other regions within China over the past three years.

主管稅務(wù)機(jī)關(guān)
In-charge tax authority

時(shí)間(年份)
Time (year)

所得金額
Amount of income

減免稅金額
Amount of tax reduction or exemption

（1）

（2）

（3）

（4）

（5）

五、附報(bào)資料清單V. List of Documents Attached

40．非居民納稅人自行選擇提供的能夠證明其符合享受協(xié)定待遇的其他資料清單
    List of other documents provided by the non-resident taxpayer on a voluntary basis to justify entitlement to tax treaty benefits

（1）

（2）

（3）

（4）

（5）

41．非居民納稅人以前已提交而此次可以免于重復(fù)提交的資料清單和提交時(shí)間
    List of documents submitted before (and need not to be resubmitted) / Date of previous submission

（1）

提交時(shí)間
Submission date

（2）

提交時(shí)間
Submission date

（3）

提交時(shí)間
Submission date

（4）

提交時(shí)間
Submission date

（5）

提交時(shí)間
Submission date

六、備注
VI. Additional Notes

七、聲明
VII. Declaration

     我謹(jǐn)聲明以上呈報(bào)事項(xiàng)真實(shí)、準(zhǔn)確、無誤。
     I hereby declare that the information given above is true, accurate and error-free.


        非居民納稅人簽章 Seal of non-resident taxpayer                                                       年        月         日
        代表人簽字  Signature of the representative                                                            Y          M         D                                          
     
                             

扣繳義務(wù)人公章：
Seal of the withholding agent:

代理申報(bào)中介機(jī)構(gòu)公章：
Seal of the tax agent:

主管稅務(wù)機(jī)關(guān)受理專用章：
Dedicated seal of the in-charge tax authority:

經(jīng)辦人：
Signature of the case handler:

經(jīng)辦人：
Signature of the case handler:

受理人：
Received by:

填表日期：           年       月       日
Date of filing:            Y      M       D

申報(bào)日期：           年       月        日
Date of filing:            Y        M        D

受理日期：           年        月        日
Date of case acceptance: Y    M    D

國家稅務(wù)總局監(jiān)制