附件5
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:
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公司或团体 Corporation or other entity |
名称Name |
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总机构所在地 Place of head office |
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邮政编码 Postcode |
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实际管理机构所在地 Place of effective management |
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邮政编码 Postcode |
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注册所在地 Place of registration |
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邮政编码 Postcode |
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二、所得事项Details of income:
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承包工程 Contracted construction |
支付人名称 Payer’s name |
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地址Address |
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邮编Postcode |
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合同名称 Name of contract |
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合同字号 Contract number |
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项目地点 Place of project |
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项目持续时间 (年/月/日-年/月/日) Duration of project (y/m/d-y/m/d) |
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劳务人数 Number of workers |
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支付金额及币种 Amount of payment（unit） |
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支付日期 Date of payment |
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所得项目 Item of income |
□承包工程 □其他(请注明) Contracted construction Others（please specify） |
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纳税方式 Method of tax payment |
□指定扣缴 Designated withholding □自行申报 Self-filing |
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提供劳务 Performance of service
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支付人名称 Payer’s name |
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地址Address |
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邮编Postcode |
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合同名称 Name of contract |
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合同字号 Contract number |
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劳务地点 Place of service |
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劳务持续时间 (年/月/日-年/月/日) Duration of service (y/m/d-y/m/d) |
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劳务人数 Number of workers |
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支付金额及币种 Amount of payment（unit） |
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支付日期 (年/月/日) Date of payment (y/m/d) |
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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） |
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纳税方式 Method of tax payment |
□指定扣缴 Designated withholding □自行申报 Self-filing |
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其他项目
Other items |
非居民名称 Name |
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支付人名称 Payer’s name |
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所得项目 Item of income |
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地址Address |
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邮编Postcode |
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支付金额及币种 Amount of payment（unit） |
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支付日期（年/月/日） Date of payment (y/m/d) |
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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).
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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）:
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收到报告表日期(年/月/日) Date of receipt (y/m/d) |
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受理人（签章） Receiver (signature) |
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备注 （Note）： |
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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.
