非居民企业承包工程作业和提供劳务享受税收协定待遇报告表
Non-resident Enterprises’ Claim for Treatment under Double Taxation Agreement
(Contracted construction and service projects)
编号 Serial Number：
一、申请人事项Details of applicant:
公司或团体
Corporation or other entity
名称Name
总机构所在地
Place of head office
邮政编码
Postcode
实际管理机构所在地
Place of effective management
邮政编码
Postcode
注册所在地
Place of registration
邮政编码
Postcode
二、所得事项Details of income:
承包工程
Contracted construction
支付人名称
Payer’s name
地址Address
邮编Postcode
合同名称
Name of contract
合同字号
Contract number
项目地点
Place of project
项目持续时间
(年/月/日-年/月/日)
Duration of project (y/m/d-y/m/d)
劳务人数
Number of workers
支付金额及币种
Amount of payment（unit）
支付日期
Date of payment
所得项目
Item of income
□承包工程 □其他(请注明)
Contracted construction Others（please specify）
纳税方式
Method of tax payment
□指定扣缴 Designated withholding □自行申报 Self-filing
提供劳务
Performance of service
支付人名称
Payer’s name
地址Address
邮编Postcode
合同名称
Name of contract
合同字号
Contract number
劳务地点
Place of service
劳务持续时间
(年/月/日-年/月/日)
Duration of service (y/m/d-y/m/d)
劳务人数
Number of workers
支付金额及币种
Amount of payment（unit）
支付日期 (年/月/日)
Date of payment (y/m/d)
劳务项目
Item of service
□设计劳务Designing □咨询劳务Consultancy □管理劳务Management
□培训服务Training □技术服务 Technical service
□销售设备同时提供劳务 Providing service in connection with equipments sold
□其它 (请注明) Others（please specify）
纳税方式
Method of tax payment
□指定扣缴 Designated withholding □自行申报 Self-filing
其他项目
Other items
非居民名称 Name
支付人名称
Payer’s name
所得项目
Item of income
地址Address
邮编Postcode
支付金额及币种
Amount of payment（unit）
支付日期（年/月/日）
Date of payment (y/m/d)
三、申请适用避免双重征税协定 Application for Treatment under Double Taxation Agreement:
我谨在此申请依据中华人民共和国与 签订的避免双重征税协定第 条第 款，因承包工程作业或提供劳务项目不构成在中国境内设有常设机构，享受不予征税待遇。
I hereby apply to be non-liable for enterprise income tax as the contracted construction or service project does not constitute a permanent establishment in China in accordance with Paragraph , Article of the Tax Agreement between the People’s Republic of China and .
四、声明 Declaration:
我谨在此声明以上呈报事项准确无误。
I hereby declare that the above statement is correct and complete to the best of my knowledge and belief.
申请人（签章）：________________
Applicant (Signature or seal)：________________
五、申请人居民身份证明（由申请人为其居民的缔约国主管税务机关填写, 或另附对方主管税务机关出具的专用证明）。Applicant’s Certificate of Resident Status (To be filled out by the responsible tax office of the State in which the applicant is a resident, or to attach the certificate provided by the responsible tax office of the State in which the applicant is a resident).
Certification
We hereby certify that (applicant’s name) is a resident of (name of State) according to the provisions of Paragraph , of Article in the __________________ (name of law).
Applicant’s serial number : Date (y/m/d) :
Signature or stamp of tax office
以下由中国主管税务机关填写（The following for the use of the responsible tax office of China only）:
收到报告表日期（年/月/日）
Date of receipt (y/m/d)
受理人（签章）
Receiver (signature)
备注 （Note）：
税务机关（盖章）
Stamp of Tax Office
注：本表一式两份，一份退申请人，一份由税务机关留存归档。
Note: This Form is in duplicate. The applicant and the tax authority concerned each has one copy.
