DOC《A03055》

四、税务机关管理使用信息 Ⅳ.Information for Use by Tax Authorities 6.根据《中华人民共和国企业所得税法》规定,依法在中国境内成立,或者依照外国(地区)法律成立但实际管理机构在中国境内的企业是中国的税收居民.根据该法律规定,非居民纳税人是否构成中国的税收居民? The Enterprise Income Tax Law prescribes that a resident enterprise refers to an enterprise that is established within the territory of China pursuant to Chinese laws or an enterprise that is established within the territory of another country or region pursuant to that country or that region's laws whose place of effective management is located in China. According to such provision, is the taxpayer a tax resident of China? 是Yes 否No 7.非居民纳税人的注册地(国家或地区) Place of registration (state or region) 非居民纳税人的实际管理机构所在地(国家或地区) Place of effective management (state or region) 非居民纳税人的总机构所在地(国家或地区) Place of head office (state or region) 8.请简要说明非居民纳税人在居民国(地区)的主要经营活动内容. Please briefly describe the main business activities of the non-resident taxpayer in the resident state (region). *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(请全部列明) For a non-resident enterprise claiming tax treaty benefits under the article of dividends, interest, royalties or capital gains, please provide information of all shareholders holding directly or indirectly at least

10 per cent of rights and interests of the enterprise. 股东名称 Name of shareholder 股东注册地址(住址) Place of registration (home address) 股东居民国(地区) Residence state (region) of the shareholder 持股比例 Ratio of holdings (1) (2) (3) (4) (5) 10.非居民纳税人从中国取得的所得在居民国(地区)纳税情况(限于列入税收协定适用范围的税种) Information of taxes paid in the resident state (region) on the income derived from China by the non-resident taxpayer (for taxes covered by the tax treaty only) 税种名称 Name of tax 法定税率 Statutory tax rate 享受居民国(地区)国内减免税优惠的法律依据及条文描述 Legal basis and provision description for the non-resident taxpayer to enjoy tax reduction or exemption in its resident state (region) (1) (2) (3) 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(涉及多个国家或地区请全部列明)? Does the non-resident taxpayer qualify as a tax resident of any other states (regions) based on the laws of such states (regions)? If yes, please specify the names of all such states (regions). *12.非居民纳税人需享受的税收协定如包含"利益限制"条款或"享受协定优惠的资格判定"条款,请简要说明非居民纳税人是否符合相关条款要求. If the treaty contains provisions of "Limitation on Benefits" or "Entitlement to Benefits", please briefly describe whether the non-resident taxpayer meets the requirements of these provisions.

五、备注 Ⅴ.Additional Notes

六、声明 Ⅵ.Declaration 我谨声明以上呈报事项真实、准确、无误. I hereby declare that the information given above is true, accurate and error-free. 非居民纳税人签章 Seal of non-resident taxpayer 20XX年XX月XX日 代表人签字 Signature of the representative Y M D 扣缴义务人公章: Seal of the withholding agent: 代理申报中介机构公章: Seal of the tax agent: 主管税务机关受理专用章: Dedicated seal of the in-charge tax authority: 经办人:王五 Signature of the case handler: 经办人: Signature of the case handler: 受理人: Received by: 填表日期:20XX年XX月XX日Date of filing:Y M D 申报日期: 年月日Date of filing:Y M D 受理日期:年月日Date of case acceptance: Y M D 国家税务总局监制