1、非居民納稅人稅收居民身份信息報告表（個人適用）Information Reporting Form of Tax Residence Status of Non-resident Taxpayer填報日期： 年 月曰Filli ng date:Y M Do自行申報o扣繳申報o退稅Self-declarati onWithhold ing declarati onTax refu nd一、扣繳義務人基本信息I.Basic Information of Wihholding Agent扣繳義務人名稱Name of withholdi ng age nt扣繳義務人納稅人識別 號Tax identif

2、ication number of withhold ing age nt二、非居民納稅人基本信息II. Basic Information of Non-residet axpayer非居民納稅人中文姓名Chin ese n ame ofnon-reside nt taxpayer非居民納稅人在居民國（地區）姓名Name of no-reside nt taxpayer in reside nt state （regio n）非居民納稅人身份證件類 型Type of ID certificate非居民納稅人身份證件 號碼Number of ID certificate非居民納稅人在中國聯系地

3、址和郵政編碼Con tact address非居民納稅人在居民國（地區）聯系地址和郵政 編碼Con tact address and postal code in the rside nt state （regio n）非居民納稅人在中國的聯 系電話Teleph one n umber in China非居民納稅人在居民國 (地區)的聯系電話Teleph one n umber in reside nt state (regi on)非居民納稅人的居民國（地區）非居民納稅人享受稅收協定名稱Name of the applicable tax treaty三、扣繳義務人使用信息III. Info

4、rmatin for Use by Withholding Agent提示： 稅收居民”是指符合締約國國內稅法中對居民定義的人，包括企業和個人。如果非居民納稅 人不是需享受稅收協定締約對方的稅收居民，則不能享受稅收協定待遇。Note: The term "tax reside nt" means any pers on (e.g. an en terprise or in dividual) who, un der the domestic tax law of a con tracti ng party to the ta treaty, shall be regarde

5、d as a reside nt. If the non-reside nt taxpayer is not a reside nt of the other con tracti ng party to the tax treaty, he/she shall not be en titled to the treatme nt un der the tax treaty.1、請引述非居民納稅人構成締約對方稅收居民的締約對方國內法律依據：Please cie the domestic legal basis based on which the non-reside nt taxpayer

6、qualifies as a tax reside nt of the other con tract ing party:2、請簡要說明非居民納稅人能構成締約對方稅收居民的事實情況:of the other con tracti ng paty:3、聲明：Declarati on:我謹聲明，我為需享受稅收協定締約對方的稅收居民，我成為締約對方稅收居民并非為了獲得 稅收協定利益而安排。I hereby declare that I am a tax reside nt of the other con tract ing party to the tax treaty and the purp

7、ose of beco ming such a tax reside nt is not to obta in the tax treaty ben efits.非居民納稅人簽章或簽字年月日Seal or sig natue of the non-reside nt taxpayerYMD四、稅務機關管理使用信息IV. Information for Use by Tax Authorities4、根據中華人民共和國個人所得稅法規定，在中國境內有住所或者 無住所而在境內居住滿一年的人是中國的稅收居民。根據該法律規定， 非居民納稅人是否構成中國的稅收居民？Accord ing to the In

8、 dividual In come Tax Law, an in dividual will be regarded as a tax reside nt of Chi na if the in dividual has a domicile in Chi na or, if the in dividual has not a domicile in China, the in dividual has lived in China for one year. Accord ing to such provisi on, is the taxpayer a tax reside nt of C

9、hina?是 Yes否No5、非居民納稅人在中國境內是否有住所？Does the non-reside nt taxpayer have a domicile in China?是 Yes否No6、非居民納稅人在中國居住時間是以下哪種情況？Which of the follow ing sce narios does the non-reside nt taxpayer fall un der concerning his or her reside nee in China? 在一個納稅年度中在中國境內連續或者累計居住不超過183天（含183天）The in dividual has liv

10、ed in China for a period or periods not exceed ing in the aggregate 183 days with in one tax year. 在一個納稅年度中在中國境內居住超過183天但不滿1年（臨時離境不扣減天數）The in dividual has lived in China for more tha n 183 days but less tha n one year withi n one tax year （days of temporary departure from China in cluded）. 在中國境內居住滿

11、1年未滿5年The in dividual has lived in China for more tha n one year but less tha n five years. 在中國境內居住滿5年（含5年）The in dividual has lived in Chi na for five years or more.7、非居民納稅人的永久性住所所在地屬于以下哪種情況？Which of the follow ing see narios does the non-reside nt taxpayer fall un der concerning his or her perma n

12、ent home?非居民納稅人僅在需享受稅收協定締約對方國家(地區)擁有永久性住所The non-reside nt taxpayer has his or her perma nent home only in the other con tract ing state (regio n).非居民納稅人僅在中國擁有永久性住所The non-reside nt taxpayer has his or her perma nent home only in China.非居民納稅人在需享受稅收協定締約對方國家(地區)和中國均擁有永久性住所The non-reside nt taxpayer ha

13、s his or her perma nent homes both in China and the other con tract ing state (regi on).非居民在需享受稅收協定締約對方國家(地區)和中國均沒有永久性住所The non-reside nt taxpayer has his or her perma nent home n either in China nor in the othr con tract ing state (regi on).8、非居民納稅人如在第三國(地區)擁有永 久性住所，請說明具體國家(地區)If the non-reside nt

14、taxpayer has apermanent home in a third state (region), please provide the n ame(s) of such state(s) or regio n(s).9、非居民納稅人的重要利益中心所在地屬于以下哪種情況？Which of the followi ng seen ariosdoes the non-reside nt taxpayer fall un der con cer ning his or her centre of vital in terests?非居民纟內稅人的重要利益中心在需享受稅收協定締約對方國家(

15、地區)The non-reside nt taxpayer hashis or her centre of vital in terests in the other con tract ing state (regi on). 非居民納稅人的重要利益中心在中國The non-reside nt taxpayer has his or her centre of vital in terests in Chi na.非居民納稅人的重要利益中心在第三國(地區)The non-reside nt taxpayer has his or hercentre of vital in terests i

16、n a third state (regio n).非居民納稅人無法確定重要利益中心在何地The non-reside nt taxpayer cannot determ ine where his or her centre of vital in terests lies.10、非居民納稅人的家庭成員主要生活地(如涉及多個國家或地區，請全部列明)Main states (regions) in which thenon-reside nt taxpayer's family members live (If there ae more tha n one states or reg

17、i ons, please list them all).11、非居民納稅人的習慣性居所所在地屬于以下哪種情況?Which of the follow ing see narios does the non-reside nt taxpayer fall un der concerning his or her habitual abode?非居民納稅人的習慣性居所在需享受稅收協定締約對方國家（地區）The non-reside nt taxpayer has his or her habitual abode in the other con tract ing state （regi on

18、）.非居民納稅人的習慣性居所在中國The non-reside nt taxpayer has his or her habitual abode in China.非居民納稅人的習慣性居所在第三國（地區）The non-reside nt taxpayer has his or her habitual abode in a third state （regi on）.非居民納稅人無法確定習慣性居住地The non-reside nt taxpayer cannot determ ine the place of his or her habitual abode.12、非居民納稅人的國籍（

19、多重國籍請全部 列明）Nati on ality of the non-reside nt taxpayer n ati on alities, please list them all）.13、非居民納稅人在中國保有的資產和經濟利益總額是否超過在需享受 稅收協定締約對方國家（地區）保有的資產和經濟利益總額？Does the total amou nt of the assets and econo mic in terests held by the non-reside nt taxpayer in Chi na exceed that in the other con trct ing

20、state （regio n）?是 Yes否No14、非居民納稅人從中國取得的所得在居民國（地區）納稅情況（限于列入稅收協定適用范圍的稅種）In formati on of taxes paid in the reside nt state （regi on） on the in come derived from Chi na by thenon-reside nt taxpayer （for taxes covered by the tax treaty only）稅種名稱Name of tax法定稅率Statutory ta rate享受居民國（地區）國內減免稅優惠的法律依據 及條文描述

21、Legal basis and provision description for the non-reside nt taxpayer to enjoy tax reducti on or exempti on in his or her reside nt state （regi on）（1）（2）（3）15、根據第三國（地區）法律規定，非居民 納稅人同時還構成哪些國家（地區）的稅收 居民（涉及多個國家或地區的請全部列明）？Does the non-reside nt taxpayer qualify asa tax reside nt of any other states （regi

22、ons） based on the laws of such states （regi on s）? Ifyes, please specify the n ames of all such states (regi on s).五、備注六、聲明我謹聲明以上呈報事項真實、準確、無誤。I hereby declare that the information given above is true, accurate and error-free.非居民納稅人簽章或簽字年月日Seal or sig nature of te non-reside nt taxpayerYMD扣繳義務人公章：Sea

23、l of the withhold ing age nt:代理申報中介機構公章：Seal of the tax age nt:主管稅務機關受理專用早：Dedicated seal of the in-charge tax authority:經辦人：Sign ature of the case han dler:填表日期：年月日Date of fili ng:YMD經辦人：Sign ature of the caseha ndler:申報日期：年 月日Date of fili ng:YMD受理人：Received by:受理日期：年月日Date of case accepta nee:Y M

24、D國家稅務總局監制【表單說明】一、本表適用于需享受我國對外簽署的避免雙重征稅協定(含與港澳避免雙重征稅安排)或國際運輸協定待遇的個人所得稅非居民納稅人。I. This form is applicable to non-reside nt in dividual in come taxpayer who claims taxben efits un der a Double Taxati on Agreeme nt (DTA, in cludi ngthe DTAs with Hong Kongand Macau Special Admi nistrative Regi ons) or Int

25、ern ati onal Tran sport Agreeme nt sig ned by China.二、本表可用于自行申報或扣繳申報，也可用于非居民納稅人申請退稅。非居民納稅人 自行申報享受協定待遇或申請退稅的，應填寫本表一式兩份，一份在申報享受協定待遇或申 請退稅時交主管稅務機關，一份由非居民納稅人留存；對非居民納稅人來源于中國的所得實 施源泉扣繳或指定扣繳管理的，非居民納稅人如需享受稅收協定待遇，應填寫本表一式三 份，一份交由扣繳義務人在扣繳申報時交主管稅務機關，一份由扣繳義務人留存備查，一份 由非居民納稅人留存。II. This form can be used for self-d

26、eclaration or withholding declaration, as well as for the non- resident taxpayer 's application for tax refund. The non -resident taxpayer initiating the self-declaration for claiming tax treaty benefits, or applying for tax refund, shall complete two copies of the form: one form is to be submit

27、ted to the in-charge tax authority at the time of such declaration or application, and the other form is to be kept by the non-resident taxpayer. Where the non-resident taxpayer ' sChina sourced income is subject to withholding tax, administered at source or by means of a designated withholding

28、agent, and the non-resident taxpayer is entitled to tax treaty benefits, the non-resident taxpayer shall complete three copies of the form: one is to be given to the withholding agent to submit to the in-charge tax authority at the time of the withholding declaration, one is to be kept by the withho

29、lding agent and another is to be kept by the non-resident taxpayer.三、本表第一部分由扣繳義務人填寫，如非居民納稅人自行申報納稅則無需填寫。本表 其余部分由非居民納稅人填寫。非居民納稅人填報本表時可根據需要增加附頁。III. Part I of the form shall be filled in by the withholding agent, and will not be required in the case of self-declaration. The rest of the form shall be fi

30、lled in by the non-resident taxpayer. When filling in the form, the non-resident taxpayer can attach separate sheets to the form if necessary.四、本表第三部分“扣繳義務人使用信息”用于在源泉扣繳或指定扣繳情況下，扣繳義 務人核對非居民納稅人是否符合享受協定待遇條件；其他部分用于稅務機關采集管理信息。IV. “ Information for use by withholding agent ”in Part III of the form is used

31、 by a withholding agent to decide if a non-resident taxpayer is eligible for tax treaty benefits in withholding at source; the rest is for the tax authority to gather information for administrative purposes.五、非居民納稅人應如實完整填寫本表所列問題。如非居民納稅人沒有問題所列情況， 請在表格中填“無”。本表所列選擇題，請非居民納稅人在符合自身情況的選項對應的或 O中打勾“ V”。V. Th

32、e non-resident taxpayer shall provide accurate and complete information to answer the questions contained in the form. Please write “N/A” itnhe form if a situation described in a question is not applicable for a non-resident taxpayer. For a multiple-choice question, please mark “V” in a correspondin

33、g box (“” ) or circle(“O” ) for a choice that fits a non-reside nt taxpayer' s situati on.六、本表采用中英文雙語制作，如中英文表述不一致，以中文以準。如無特別說明，應 使用中文填寫。VI. This form is prepared in Chinese and English. In case of divergence in the two languages, the Chinese text shall prevail. Unless otherwise stated, it shall

34、be completed in Chinese.七、本表各欄填寫如下：VII. Instructions on how to fill in each item are as follows:（一）扣繳義務人基本信息（I）. Basic Information of Withholding Agent1. 扣繳義務人名稱：由扣繳義務人填寫稅務登記證所載扣繳義務人的全稱。Name of withholding agent: The withholding agent should provide its full name as shown in its tax registration cer

35、tificate.2. 扣繳義務人納稅人識別號：由扣繳義務人填寫扣繳義務人稅務登記證上注明的“納 稅人識別號”。Tax identification number of withholding agent: The withholding agent should provide its identification number as shown in the tax registration certificate.（二）非居民納稅人基本信息（II）. Basic Information of Non-resident Taxpayer3. 非居民納稅人在居民國 （地區） 姓名：填寫非居民

36、納稅人身份證件上的英文全名，如 護照上的英文全名。Name of non-resident taxpayer in resident state （region）: Fill in the full English name of the non-resident taxpayer as shown in his/her ID document, such as the full English name on the passport.4. 非居民納稅人身份證件類型：填寫能識別非居民納稅人唯一身份的有效證照名稱，如 護照。Type of ID certificate: Fill in the

37、 name of the valid certificate that can identify the sole identity of the non-resident taxpayer, such as a passport.5. 非居民納稅人身份證件號碼：填寫非居民納稅人身份證件上的號碼，如護照號碼。Number of ID certificate: Fill in the number of the ID document of the non-resident taxpayer, such as the passport number.6. 非居民納稅人的居民國（地區）：填寫非居民

38、納稅人為其稅收居民的獨立稅收管轄區 的名稱。如果非居民納稅人是香港、澳門稅收居民，請填寫“香港特別行政區”或“澳門特 別行政區”。Resident state （region）: Fill in the name of the independent tax jurisdiction where the non-resident taxpayer is a resident. Tax resident of Hong Kong or Macau SARs should indicate "Hong Kong SAR" or "Macau SAR" as

39、appropriate.（三）扣繳義務人使用信息（III）. Information for Use by Withholding Agent7. 問題 1，請引述非居民納稅人構成締約對方稅收居民的締約對方國內法律依據：填寫 締約對方國家（或地區）如何定義和判定其稅收居民的國內法律條文。請寫明法律條文所屬 法律法規名稱和條款序號，并引述相關法律條文。Question 1, “ Pleasecite the domestic legal basis based on which the non -resident taxpayer qualifies as a tax resident of t

40、he other contracting party” : Quote the domestic lawof the other contracting state （region） on how to define and determine tax residency. Specify the name of the law and the number of relevant clauses, and specific provisions.8. 問題 2，請簡要說明非居民納稅人構成締約對方稅收居民的事實情況：在此欄中填寫 非居民納稅人符合需享受協定的締約對方國家（或地區）國內構成稅收居

41、民的法律標準的具 體事實。例如締約對方國內法采用住所標準判定稅收居民的，非居民納稅人應說明住所情 況，如締約對方國內法采用居住時間標準判定稅收居民的，非居民納稅人應說明在締約對方 的居住或停留時間情況。Question 2, “ Please briefly describe the facts based on which the non -resident taxpayer qualifies as a tax resident of the other contracting party” : Provide facts in supportof the claim that the n

42、on-resident taxpayer qualifies as a tax resident of the other contracting state （region）. For example, where the other contracting party determines tax residency through domicile, the non-resident taxpayer should provide facts regarding his or her domicile. Where such determination is based on the c

43、riterion of residence duration, the non-resident taxpayer should provide relevant details accordingly.（四）稅務機關管理使用信息（IV）. Information for Use by Tax Authorities9. 問題 5，非居民納稅人在中國境內是否有住所：根據中華人民共和國個人所得稅法 實施條例，“在中國境內有住所”是指因戶籍、家庭、經濟利益關系而在中國境內習慣性 居住。Question 5, “ Doesthe non - resident taxpayer have a domi

44、cile in China? ” : Based on "Implementation Rules of the Individual Income Tax Law Of the People's Republic of China", "individuals who have domiciles in China" refer to individuals who by reason of their permanent residence, family relations or economic interests, habitually

45、 reside in the People's Republic of China.10. 問題 7，非居民納稅人的永久性住所所在地屬于以下哪種情況：永久性住所包括任 何形式的住所，例如由個人租用的住宅或公寓、租用的房間等，但該住所必須具有永久性， 即個人已安排長期居住，而不是為了某些原因（如旅游、商務考察等）臨時逗留。Question 7, “ Which of the follow ing scenarios does the non-resident taxpayer fall under concerning his or her permanent home?” : Perm

46、anent home in this form includes anyresidential location, such as house, apartment or room rented by the taxpayer. Such residential location, however, should be permanent in nature, i.e. the taxpayer's stay at this location should be long-term rather than temporary （e.g. for tourism or business

47、purposes）.11. 問題 9，非居民納稅人的重要利益中心所在地屬于以下哪種情況：非居民納稅人個人 一直居住、工作并且擁有家庭和財產的國家或地區通常為其重要利益中心之所在。Question 9, “ Which of the following scenarios does the non-resident taxpayer fall under concerning his or her center of vital interests?” : Typica-lrlyesthideentotnaxpayer'scenter of vital interests liesin

48、the state or region where he or she permanently resides,works, and owns family and properties.12. 問題 14，非居民納稅人從中國取得的所得在居民國（地區）納稅情況：法定稅率根 據居民國（地區）國內法的規定填寫。如非居民納稅人享受了居民國（地區）國內減免稅優 惠，請寫明非居民納稅人所享受減免稅優惠的法律條文所屬法律法規名稱和條款序號，并引 述相關法律條文。如非居民納稅人未享受居民國（地區）國內減免稅優惠，在“享受居民國 （地區）國內減免稅優惠的法律依據及條文描述”欄填“無”。Question 14, “ Information of taxes paid in the resident state （region） on the income derived from China by the non- resident taxpayer” : Statutory tax rate refers to the tax rate asprescribed in the domestic law of the resident state （region）. If th