各行署、市国家税务局，平朔涉外分局： 现将国税函发（1995）089号关于修改《外国居民享受避免双重征税协定待遇申请表》的通知及表式转发给你们，省局将统一印制此表，各 地市在1995年7月1日前来省局涉外税处领取。 一九九五年三月二十四日 国家税务总局关于修改《外国居民享受避免双重征税协定待遇申请表》的通知 各省、自治区、直辖市和计划单列市国家税务局： 根据税制改革后的需要，我局对1991年7月1日下发使用的《外国居民享受避免双重征税协定待遇申请表》（国税函发[1994]1012号）进行 了修改。现将修改后的式样印发你局。请根据你局需要自行印制，于1995年7月1日开始使用。 一九九五年三月六日 附表： 关于填写外国居民享受避免双重征税协定待遇申请表的说明 一、填报范围程序 （一）本表适用同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）国家居民取得来源于中国的股息、利息、特许权使用费， 以及个人劳务所得申请享受税协定特遇填报。 （二）本表由受益所有人或所得人埴写，一式两份，一并送交支付人，由支付人报送当地税务机关，当地税务机关审核认可后，退还支付 人一份据以执行。 二、本表填写说明 （一）申请人事项： 1、个人住所或居民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。 2、公司或团体名称填写或团体的全称；总机构、实际管理机构或注册所在地，填写申请人在税收上为其居民国家的总机构所在地、实际管 理机构所在地或注册所在地的地址及邮政编码。 （二）所得事项 个人劳务所得中的职业填写申请人为独立个人劳务或非独立个人劳务，所得项目是指工资、薪金或劳务报酬。 （三）其他事项 申请人填写对表列各项或其它需要说明的事项 （四）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）级税务机关所盖本级公章。 Instructlons of the "Application for Treatment under Double Taxation Agreement" 1、scope and procedure of filling the form (1)The Form is applicable to those who are residents of thecountries concluded the Agreement for the Avoidence of Double Taxation(hereinafter referred to as the "Tax Agreenment")with the People‘s Republic of China ,and who claim for treatmants of the Tax Agreenment with respect to dividends, interest,royalties and personal services income derived from china. (2)The Form is completed by beneficial owner or income reciplent in duplicate and forwarded to the payer, then submitted to the relevant local tax office by the latter. One piece of the duplicate will be returned to the payer for the enforcement upon tax office‘s examination and approval. 2、Instructions fot items in the Form。 (1)"Details of Claimant" ——、Individual‘s domicile of residence, state the address of claimant‘s domicile or residence as well as postcode in the country of claimant being a resident for the purpose of tax. ——、Name of corporation or other entity, give full name,Place of head office,effective management or registration, give address and postcode in the country of claimant beging a resident for the purpose of tax。 (2)"Details of Income" "Occupstion "in the personal service income column refers to independent or dependent personal service of the claimant; “item of income” includes wages, salaries or service remuneration. (3)Others: Notes necessary by claimant on the items Listed in the form or others. (4)At the close of the Form,"Stamp of tax office"means officlal stamp at the level of tax office of the county (city) of China that is in charge of the said taxation declared by claircant。 {外国居民享受避免双重征税协定待遇申请表}