非居民纳税人享受税收协定待遇情况报告表(企业所得税A表)

非居民纳税人享受税收协定待遇情况报告表（企业所得税A表）
Reporting Form for Non-resident Taxpayer Claiming Tax Treaty Benefits
(Form A for Enterprise Income Tax)

（享受税收协定股息、利息、特许权使用费条款待遇适用）
(Applicable to Tax Treaty Benefits under Articles of Dividends, Interest or Royalties)

填表日期：      年   月   日
Filling date:        Y    M    D      

货币单位：元人民币
Currency unit: RMB

     ○ 自行申报                  ○ 扣缴申报                               ○ 退税
         Self-declaration                Withholding declaration                Tax refund

一、扣缴义务人基本信息
I. Basic Information of Withholding Agent

扣缴义务人名称
Name of withholding agent

扣缴义务人纳税人识别号
Tax identification number of withholding agent

二、非居民纳税人基本信息
II. Basic Information of Non-resident Taxpayer

非居民纳税人中文名称
Chinese name of non-resident taxpayer

非居民纳税人在中国的纳税人识别号
Tax identification number of non-resident taxpayer in China

非居民纳税人在居民国（地区）的名称
Name of non-resident taxpayer in resident state (region)

非居民纳税人在居民国（地区）纳税人识别号
Tax identification number of non-resident taxpayer in resident state (region)

非居民纳税人享受税收协定名称
Name of the applicable tax treaty

所得类型
Type of income

○ 股息 Dividends            ○ 利息 Interest         ○ 特许权使用费 Royalties

三、扣缴义务人使用信息III. Information for Use by Withholding Agent

（一）享受股息条款待遇
  (I) Claiming Tax Treaty Benefits under the Article of Dividends

1．非居民纳税人类型
    Type of non-resident taxpayer
  （1）□政府、政府机构 
               Government or governmental body
  （2）□税收协定缔约对方政府直接或间接拥有至少20%股份的缔约对方居民公司 
               Resident company of the other tax treaty contracting party with no less than 20% of its shares held by the government of the other contracting party, whether directly or indirectly
  （3）□税收协定缔约对方政府直接或间接全部拥有资本的其他实体 
                Other entity with all its capital held by the government of the other tax treaty contracting party, whether directly or indirectly
  （4）□其他公司 
               Other companies
  （5）□合伙企业 
               Partnership enterprises
  （6）□其他组织类型                  请说明 Please specify：_____________________________________________
               Other types of entity   

2．非居民纳税人直接拥有支付股息的公司的股份比例
    Direct shareholding percentage of the non-resident taxpayer in the dividend paying company

3．非居民纳税人直接拥有股份比例在取得股息前的12个月内是否曾有低于25%（不含25%）的情况？
    Has the direct shareholding percentage of the non-resident taxpayer in the dividend paying company been less than 25% (excluding 25%) at any time during the 12 months prior to the declaration of the dividends?

  □  是  Yes
  □  否   No

*4．非居民纳税人直接或间接拥有支付股息公司的股份比例合计    
    Percentage of total share capital held, directly and indirectly, by the non-resident taxpayer in the dividend paying company

    非居民纳税人在该公司的投资金额
    Amount of investment in the dividend paying company by the non-resident taxpayer

金额：
Amount:

币种：
Currency:

（二）享受利息条款待遇
  (II) Claiming Tax Treaty Benefits under the Article of Interest

5．非居民纳税人是否是税收协定列明利息所得免税组织或机构？
    Is the non-resident taxpayer listed as an organization or institution specifically exempt from source country tax on interest in the tax treaty?

  □  是  Yes
  □  否   No

6．非居民纳税人类型
    Type of non-resident taxpayer
  （1）□税收协定缔约对方的政府、行政区、地方当局 
                Government, political subdivision, local authority of the other tax treaty contracting party
  （2）□税收协定缔约对方中央银行 
               Central Bank of the other tax treaty contracting party
  （3）□银行 
               Bank
  （4）□其他金融机构 
               Other financial institution
  （5）□其他企业或组织
              Other business or organization

7．非居民纳税人是否完全为税收协定缔约对方的政府所有？    Is the non-resident taxpayer wholly-owned by the government of the other tax treaty contracting party?

   □  是  Yes   □  否  No

*8．贷款资金是否存在以下情况
    Do any of the following circumstances apply in respect of the loaned monies?
   （1）□由税收协定缔约对方符合条件的政府或机构间接提供资金
                The loaned monies are indirectly provided by government or institution of the other tax treaty contracting party in circumstances in which such indirectly financed loans qualify for benefits under the terms of the treaty
   （2）□由税收协定缔约对方符合条件的政府或机构提供担保
                A guarantee is provided by a government or institution of the other tax treaty contracting party  in circumstances in which such guaranteed loans qualify for benefits under the terms of the treaty
   （3）□由税收协定缔约对方符合条件的政府或机构提供保险
                Insurance is provided by a government or institution of the other tax treaty contracting party  in circumstances in which such insured loans qualify for benefits under the terms of the treaty

*9．如贷款资金由税收协定缔约对方符合条件的政府或机构间接提供资金或担保或保险，请填写符合条件的政府或机构全称
    Please provide the full name of the qualified government or institution if loans/funds, a guarantee or insurance are indirectly provided by a qualified government or institution of the other tax treaty contracting party

（三）享受特许权使用费条款待遇
 (III) Claiming Tax Treaty Benefits under the Article of Royalties

10．据以产生该项特许权使用费的权利或财产属于以下哪种类型？
    To which of the following types of right or property do the royalties fall into?
  （1）□文学、艺术或科学著作
                 Literature, artistic or scientific work
  （2）□专利、商标、设计、模型、图纸、秘密配方或秘密程序
                 Patent, trade mark, design, model, plan, secret formula or process
  （3）□工业、商业、科学设备
                 Equipment for industrial, commercial or scientific use
  （4）□有关工业、商业、科学经验的信息
                 Information concerning industrial, commercial and scientific experience
  （5）□其他特许权使用费 
                 Other royalties

11．该所得是否属于飞机、船舶租赁所支付的特许权使用费？
    Is the income attributable to a royalty paid for aircraft leasing or ship chartering?  

   □ 是  Yes
   □ 否  No

12．请简要描述据以产生特许权使用费所得的具体权利或财产。
    Please give a brief description of the specific right or property from which the royalty income derives.

（四）其他信息  (IV) Other Information

13．该项所得是否与非居民纳税人设在中国的常设机构或固定基地有实际联系？
    Is the income effectively connected with a permanent establishment or fixed base of the non-resident taxpayer in China?

   □ 是  Yes
   □ 否  No

14．非居民纳税人是否通过代理人取得该项所得？
    Did the non-resident taxpayer receive the income via an agent?

   □ 是  Yes
   □ 否  No

15．非居民纳税人为该项所得的“受益所有人”的声明
    Statement by non-resident taxpayer as the "beneficial owner" of the income

    提示：“受益所有人”是指对所得或所得据以产生的权利或财产具有所有权和支配权的人。如果非居民纳税人不是来源于中国的股息、利息或特许权使用费所得的受益所有人，则不能享受税收协定待遇。
    Note: A "beneficial owner" refers to a person that owns and has the right to dispose of the income or the rights or property from which such income derives. A non-resident taxpayer who is not the beneficial owner of the dividends, interest or royalties sourced in China is not entitled to the tax treaty benefits.

（1）非居民纳税人是否对所得或所得据以产生的财产或权利具有控制权或处置权？
        Does the non-resident taxpayer have control over or the right to dispose of the income or the property or rights from which such income derives?

   □ 是  Yes
   □ 否  No

（2）非居民纳税人是否对所得或所得据以产生的财产或权利承担相应风险？
        Does the non-resident taxpayer bear the risks associated with the income or the property or rights from which such income derives?

   □ 是  Yes
   □ 否  No

（3）非居民纳税人据以取得该项所得的有关权利或财产是否为获得税收协定的减免税利益而安排？
        With respect to the property or rights from which the non-resident taxpayer derives the income, have arrangements been made in such a way so as to gain access to the treaty benefits of tax exemption or reduction?

   □ 是  Yes
   □ 否  No

（4）声明：
        Declaration:

    我谨声明，我为该项所得的受益所有人，我取得该项所得的有关权利并非为了获得税收协定利益而安排。
     I hereby declare that I am the beneficial owner of the income, and arrangements have not been made, with repect to the rights from which the income derives, for the purpose of gaining tax treaty benefits.


                                 非居民纳税人签章或签字                                                      年          月          日
                                 Seal or signature of non-resident taxpayer                                  Y           M            D

16．享受税收协定待遇的优惠税率（或实际征收率）
    Preferential tax rate under tax treaty treatment (or actual tax rate)

四、税务机关管理采集信息IV. Information for Use by Tax Authorities

（一）享受股息条款待遇
  (I) Claiming Tax Treaty Benefits under the Article of Dividends

*17．非居民纳税人是否为税收协定缔约对方的上市公司？
    Is non-resident taxpayer a listed company in the other tax treaty contracting party?

  □ 是 请填写问题19
      Yes. Please answer Question 19
  □ 否  No

*18．非居民纳税人是否为税收协定缔约对方居民且在缔约对方上市的公司100%直接或间接拥有（不含通过不属于中国居民或缔约对方居民的第三方国家或地区居民企业间接持有股份的情况）？
    Is the non-resident taxpayer held 100%, directly or indirectly, by a resident of the other tax treaty contracting party, which is a listed company in the other tax treaty contracting party as well (indirect shareholdings by residents of a third state or region, other than residents of China or the other tax treaty contracting party, is excluded )?

  □ 是 请填写问题19
      Yes. Please answer Question 19
  □ 否  No

*19．上市证券交易所名称
Name of the stock exchange

上市股票代码
Stock code

（二）享受利息条款待遇
  (II) Claiming Tax Treaty Benefits under the Article of Interest

20．贷款合同利率
    Interest rate for loan contract                                                                                 

    同期市场利率
    Market interest rate of the same period

    还款条件
    Repayment terms

21．非居民纳税人与利息支付人之间是否有关联关系？
    Is there any related party relationship between non-resident taxpayer and interest payer?

   □ 是  Yes
   □ 否  No

22．在利息据以产生和支付的贷款合同之外，非居民纳税人与第三人之间是否存在在数额、利率和签订时间等方面相近的其他贷款或存款合同?
    Apart from the loan agreement in respect of which interest arises and is paid, are there any other loan or deposit contracts between the non-resident taxpayer and a third party which are similar in terms of the amount, interest rate, date of signing and other aspects?  

  □  是 请在下一题中说明 
        Yes. Please specify in the next question
  □  否 No

*23．请简要说明非居民纳税人与第三人之间合同情况（包括第三人名称、第三人与非居民纳税人的关系、合同签约日期、金额、期限、利率、付息与还款条件、担保人等）
    Please give a brief account of the contract(s) entered into between the non-resident taxpayer and the third party (including the name of the third party, the relationship between the non-resident taxpayer and the third party, date of contract signing, contract amount, contract period, interest rate, interest and principal repayment terms, guarantor, etc.).

（三）享受特许权使用费条款待遇   (III) Claiming Tax Treaty Benefits under the Article of Royalties

24．对据以产生特许权使用费的权利或财产，非居民纳税人是否拥有权属证明?如有，可另附权属证明材料。
    Does the non-resident taxpayer have an ownership certificate with respect to the rights or property from which the royalties derive? If so, the copy of the certificate may be attached separately.

   □ 是  Yes
   □ 否  No

25．非居民纳税人与特许权使用费支付人之间是否有关联关系？
    Is there a related party relationship between non-resident taxpayer and royalty payer?

   □ 是  Yes
   □ 否  No

26．在特许权使用费据以产生和支付的版权、专利、技术等使用权转让合同之外，非居民纳税人与第三人之间是否存在在有关版权、专利、技术的使用权或所有权方面的转让合同？
    Apart from transfer agreement under which the right to use copyright, patent, technology or other rights arises and under which the royalty is paid, are there any other transfer agreements, between the non-resident taxpayer and a third party, concerning the right to use or ownship of  related copyright, patent, technology or other rights?  

  □ 是 请在下一题中说明 
       Yes.   Please specify in the next question
  □ 否 No

*27．请简要说明非居民纳税人与第三人之间合同情况（包括第三人名称、第三人与非居民纳税人的关系、合同签约日期、金额、期限、受让使用条件、收费方式等）
    Please give a brief account of the contract(s) entered into between the non-resident taxpayer and the third party (including the name of the third party, the relationship between the non-resident taxpayer and the third party, date of contract signing, contract amount, contract period, conditions of use by licensee, manner in which fees are to be paid, etc.).

*28．如果非居民纳税人因转让或许可专有技术使用权而取得特许权使用费，请回答下列问题
     Where the non-resident taxpayer has transferred or licensed the right to use know-how and derives royalties therefrom, please answer the following questions

（1）非居民纳税人是否派人员为该项技术的使用提供有关支持、指导等服务并收取服务费？
         Does the non-resident taxpayer send employees to provide assistance, guidance or other services related to the use of the know-how, and charge a service fee for this?

  □ 是  请回答下面两个问题
       Yes.  Please answer the following two questions
  □ 否  No

（2）非居民纳税人派遣人员在中国为该项技术的使用提供有关支持、指导等服务连续或累计持续的时间（月数或天数）
         Please state the cumulative time which the dispatched employees spend in China, on a continuous or successive basis, in rendering the assistance, guidance or other services related to the use of the know-how (months or days basis)

（3）非居民纳税人派人员为该项技术的使用提供有关支持、指导等服务是否已构成设在中国的常设机构？
        Does the non-resident taxpayer, by sending employees to China to render the assistance, guidance or other services related to the use of the know-how, give rise to a permanent establishment?

   □ 是  Yes
   □ 否  No

（四）其他信息  (IV) Other Information

29．请简要说明除持有该项所得据以产生的权利或财产外，非居民纳税人的其他经营活动情况和其他财产情况
    Please give a brief account of operating activities and assets of the non-resident taxpayer, other than the rights or property from which the income derives.

30．非居民纳税人上一会计年度财务情况
    Financial position of the previous fiscal year of the non-resident taxpayer

注册资本：
Registered capital:

管理费用金额：
General and administrative expenses:

董事费金额：
Directors' fees:

工资薪金总额：
Sum of employees' wages and salaries:

31．非居民纳税人最近一次举行董事会情况
    Information on the non-resident taxpayer's most recent board meeting

时间：
Time:

地点：
Location:

32．非居民纳税人是否有义务在收到所得的12个月内将所得的全部或绝大部分（60%以上）支付或派发给第三国（地区）居民?
     Is the non-resident taxpayer obligated to pay or distribute all or most of (above 60% of) the income to residents of a third state (region) within 12 months after the receipt of the income?

 □ 是  请填写下面2个问题
      Yes.  Please fill in the following two questions
  □ 否 No

*33．非居民纳税人在取得该项所得后的12个月内有义务对外支付或派发的情况
    Non-resident taxpayer is obligated to pay or distribute the income within 12 months after receipt

收款方名称
Name of recipient

收款方居民国（地区）
Resident state (region) of recipient

支付比例
Payment percentage

支付时间
Time of payment

*34．请简要说明对该项所得进行上述处理的理由
    Please briefly account for the above treatment of the income.

35．缔约对方国家（地区）对此项所得的税务处理情况    Tax treatment of the income in the other contracting party      □不征税                      □免税                     □征税税率小于等于12.5%                         □其他        Not liable to tax             Exempt                    Tax rate less than or equal to 12.5%           Others

*36．如果非居民纳税人通过代理人取得该项所得，请填写以下问题
    If the non-resident taxpayer receives the income through an agent, please fill in the following questions

  （1）代理人名称
           Name of the agent

  （2）代理人收费标准和条件
           Standard service charge and terms of agency relationship

  （3）与代理相关的风险和收益是否由非居民纳税人承担？
           Does the non-resident taxpayer assume the risks and enjoy the benefits in relation to the assets held and income passing via the agent?

   □ 是  Yes
   □ 否  No

  （4）请简要说明代理关系双方的权利和义务。
           Please give a brief account of the right and obligations of both parties in the agency relationship.

37．非居民纳税人近三年是否有来源于中国境内其他地区的同类所得？
    Has the non-resident taxpayer received any income of the same type sourced in other regions within China over the past three years?

   □ 是  Yes
   □ 否  No

*38．非居民纳税人近三年是否就来源于中国境内其他地区的同类所得享受过税收协定待遇？ 
    Has the non-resident taxpayer claimed tax treaty benefits for the income of the same type sourced in other regions within China over the past three years?

   □ 是  Yes
   □ 否  No

*39．请说明非居民纳税人近三年就来源于中国境内其他地区的同类所得享受税收协定待遇的情况
    Please indicate the details of any tax treaty benefits claimed by the non-resident taxpayer for the same type of income sourced in other regions within China over the past three years.

主管税务机关
In-charge tax authority

时间(年份)
Time (year)

所得金额
Amount of income

减免税金额
Amount of tax reduction or exemption

（1）

（2）

（3）

（4）

（5）

五、附报资料清单V. List of Documents Attached

40．非居民纳税人自行选择提供的能够证明其符合享受协定待遇的其他资料清单
    List of other documents provided by the non-resident taxpayer on a voluntary basis to justify entitlement to tax treaty benefits

（1）

（2）

（3）

（4）

（5）

41．非居民纳税人以前已提交而此次可以免于重复提交的资料清单和提交时间
    List of documents submitted before (and need not to be resubmitted) / Date of previous submission

（1）

提交时间
Submission date

（2）

提交时间
Submission date

（3）

提交时间
Submission date

（4）

提交时间
Submission date

（5）

提交时间
Submission date

六、备注
VI. Additional Notes

七、声明
VII. 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                                                       年        月         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：
Signature of the case handler:

经办人：
Signature of the case handler:

受理人：
Received by:

填表日期：           年       月       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