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AER UEY ZEg E  E E E |E} E E E  7 80^E\l~zNY(W,{ NV0W:S b g8lEN'`OO@b fwQSOV[0W:S If the non-resident taxpayer has a permanent home in a third state (region), please provide the name(s) of such state(s) or region(s).E%  7 100^E\l~zNv[^bXT;Nu;m0WYmSY*NV[b0W:S hQRf Main states (regions) in which the non-resident taxpayer's family members live (If there are more than one states or regions, please list them all).E&  7c 110^E\l~zNv`N`'`E\@b@b(W0W^\NN NTy`Q Which of the following scenarios does the non-resident taxpayer fall under concerning his or her habitual abode? % ^E\l~zNv`N`'`E\@b(WNSz6eOS[~[eV[0W:S The non-resident taxpayer has his or her habitual abode in the other contracting state (region). % ^E\l~zNv`N`'`E\@b(W-NV The non-resident taxpayer has his or her habitual abode in China. % ^E\l~zNv`N`'`E\@b(W,{ NV0W:S The non-resident taxpayer has his or her habitual abode in a third state (region). % ^E\l~zNelnx[`N`'`E\OO0W The non-resident taxpayer cannot determine the place of his or her habitual abode.E E E !E" #E3 E E E E   7 120^E\l~zNvVM|Y͑VM|hQRf Nationality of the non-resident taxpayer (If the non-resident taxpayer has multiple nationalities, please list them all).E  7 130^E\l~zN(W-NVO gvDNT~Nm)Rv;`/f&TǏ(WNSz6eOS[~[eV[0W:S O gvDNT~Nm)Rv;` Does the total amount of the assets and economic interests held by the non-resident taxpayer in China exceed that in the other contracting state (region)?E<  7 140^E\l~zNN-NVS_v@b_(WE\lV0W:S ~z`QPNReQz6eOS[(uVvzy Information of taxes paid in the resident state (region) on the income derived from China by the non-resident taxpayer (for taxes covered by the tax treaty only)E/  7 1509hnc,{ NV0W:S l_ĉ[ ^E\l~zN Te؏gbTNV[0W:S vz6eE\lmSY*NV[b0W:SvhQRf  Does the non-resident taxpayer qualify as a tax resident of any other states (regions) based on the laws of such states (regions)? If yes, please specify the names of all such states (regions).E<  7E N0,gh(uNNSbV[Y~{rvMQS͑_zOS[+TN/noMQS͑_z[c bVEЏOS[_Gv*NN@b_z^E\l~zN0 I. This form is applicable to non-resident individual income taxpayer who claims tax benefits under a Double Taxation Agreement (DTA, including the DTAs with Hong Kong and Macau Special Administrative Regions) or International Transport Agreement signed by China.E>  7w  N0,gh,{NR1ucb4INRNkXQ Y^E\l~zNL3ub~zRekXQ0,ghvQYOR1u^E\l~zNkXQ0^E\l~zNkXb,gheS9hncXRDu0 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 filled in by the non-resident taxpayer. When filling in the form, the non-resident taxpayer can attach separate sheets to the form if necessary. J  7 N0^E\l~zN^Y[[tekXQ,gh@bR0Y^E\l~zNl g@bR`Q (Whk^S v^_vsQl_age0E  E 7 8.2 {f^E\l~zNgb~[ez6eE\lvN[`Q(Wdkh-NkXQ^E\l~zN&{TNSOS[v~[eV[b0W:S VQgbz6eE\lvl_hQvwQSON[0OY~[eVQlǑ(uOO@bhQ$R[z6eE\lv ^E\l~zN^fOO@b`Q Y~[eVQlǑ(uE\OOehQ$R[z6eE\lv ^E\l~zN^f(W~[evE\OOb\PYue`Q0E  E 7R 9.5 ^E\l~zN(W-NVXQ/f&T gOO@b9hnc 0-NNSNlqQTV*NN@b_zl[eagO 0  (W-NVXQ gOO@b /fcV7bM|0[^0~Nm)RvsQ| (W-NVXQ`N`'`E\OO0   - . 6 7  7s 10.7 ^E\l~zNv8lEN'`OO@b@b(W0W^\NN NTy`Q8lEN'`OO@bSbNUOb__vOO@b OY1u*NNy(uvOO[blQ[0y(uv?bI{ FOOO@b_{wQ g8lEN'` sS*NN][cgE\OO N/f:NNgNSVYe8n0FUR[I{ 4NeYu0E  E 7L 11.9 ^E\l~zNv͑)Rv-N_@b(W0W^\NN NTy`Q^E\l~zN*NNNvE\OO0]\Ov^Nb g[^T"NvV[b0W:S8^:NvQ͑)Rv-N_KN@b(W0    7 12.14 ^E\l~zNN-NVS_v@b_(WE\lV0W:S ~z`Ql[zs9hncE\lV0W:S VQlvĉ[kXQ0Y^E\l~zNNSNE\lV0W:S VQQMQzO` Qf^E\l~zN@bNSQMQzO`vl_age@b^\l_lĉ TyTag>k^S v^_vsQl_age0Y^E\l~zN*gNSE\lV0W:S VQQMQzO` (W NSE\lV0W:S VQQMQzO`vl_OncSagec hkX e 0    7 13.15 9hnc,{ NV0W:S l_ĉ[ ^E\l~zN Te؏gbTNV[0W:S vz6eE\lYgOnc-NVT^E\l~zNNSOS[~[eV[0W:S KNYv,{ NV0W:S l_ĉ[ ^E\l~zN Tegb,{ NV0W:S vz6eE\l Qf,{ NV0W:S Ty YmSY*NV[b0W:Sv hQRf0E  E 7 Non-resident taxpayer can provide other information that the non-resident taxpayer believes should be considered by the in-charge tax authority about the non-resident taxpayer s residence status. Please specify the special situations in the additional notes, if any. 7  30Xf Declaration: b(Xf b:NNSz6eOS[~[evz6eE\l bb:N~[ez6eE\lv^^:NN_z6eOS[)Rv [c0 I hereby declare that I am a tax resident of the other contracting party to the tax treaty and the purpose of becoming such a tax resident is not to obtain the tax treaty benefits. ^E\l~zN~{zb~{W[ t^ g e Seal or signature of the non-resident taxpayer Y M DFI!FUI F+IyFzIFIFI 7m V0,gh,{ NR cb4INRNO(uOo` (uN(Wnlcb4bc[cb4`Q N cb4INRN8h[^E\l~zN/f&T&{TNSOS[_GagNvQNR(uNzR:gsQǑƖ{tOo`0 IV.  Information for use by withholding agent in Part I< II of the form is used 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.    O  7WQuestion 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 support of the claim that the non-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 criterion of residence duration, the non-resident taxpayer should provide relevant details accordingly. 7 10_^E\l~zNgb~[ez6eE\lv~[eVQl_Onc Please cite the domestic legal basis based on which the non-resident taxpayer qualifies as a tax resident of the other contracting party: E"  7  90^E\l~zNv͑)Rv-N_@b(W0W^\NN NTy`Q Which of the following scenarios does the non-resident taxpayer fall under concerning his or her centre of vital interests? % ^E\l~zNv͑)Rv-N_(WNSz6eOS[~[eV[0W:S The non-resident taxpayer has his or her centre of vital interests in the other contracting state (region). % ^E\l~zNv͑)Rv-N_(W-NV The non-resident taxpayer has his or her centre of vital interests in China. % ^E\l~zNv͑)Rv-N_(W,{ NV0W:S The non-resident taxpayer has his or her centre of vital interests in a third state (region). % ^E\l~zNelnx[͑)Rv-N_(WUO0W The non-resident taxpayer cannot determine where his or her centre of vital interests lies.E E E ;E< >EO E E ,E- /EC  7 Question 15,  Does the non-resident taxpayer qualify as a tax resident of other states (regions) based on the laws of such states (regions)? : If the taxpayer qualifies as a tax resident of a third state (region) other than China or the other contracting state (region) based on the law of that third state (region), specify the name of that state (region). If more than one states or regions are relevant, please specify all of them. 7  ^E\l~zNz6eE\lNOo`bJTh *NN(u DK 79  N0cb4INRNO(uOo` III. Information for Use by Withholding AgentC  7@ 409hnc 0-NNSNlqQTV*NN@b_zl 0ĉ[ (W-NVXQ gOO@bbeOO@b (WXQE\OOnNt^vN/f-NVvz6eE\l09hncl_ĉ[ ^E\l~zN/f&Tgb-NVvz6eE\l According to the Individual Income Tax Law, an individual will be regarded as a tax resident of China if the individual has a domicile in China or, if the individual has not a domicile in China, the individual has lived in China for one year. According to such provision, is the taxpayer a tax resident of China?FRI 7  70^E\l~zNv8lEN'`OO@b@b(W0W^\NN NTy`Q Which of the following scenarios does the non-resident taxpayer fall under concerning his or her permanent home? % ^E\l~zNN(WNSz6eOS[~[eV[0W:S b g8lEN'`OO@b The non-resident taxpayer has his or her permanent home only in the other contracting state (region). % ^E\l~zNN(W-NVb g8lEN'`OO@b The non-resident taxpayer has his or her permanent home only in China. % ^E\l~zN(WNSz6eOS[~[eV[0W:S T-NVGWb g8lEN'`OO@b The non-resident taxpayer has his or her permanent homes both in China and the other contracting state (region). % ^E\l(WNSz6eOS[~[eV[0W:S T-NVGWl g8lEN'`OO@b The non-resident taxpayer has his or her permanent home neither in China nor in the other contracting state (region).E E E (E) *E< E E 1E2 3ES  7]Question 1,  Please cite the domestic legal basis based on which the non-resident taxpayer qualifies as a tax resident of the other contracting party : Quote the domestic law of 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. 7Instructions for Filling out the Information Reporting Form of Tax Residence Status of Non-resident Taxpayer (for Individuals)  7  c:y z6eE\l /fc&{T~VVQzl-N[E\l[INvN SbONT*NN0Yg^E\l~zN N/fNSz6eOS[~[evz6eE\l R NNSz6eOS[_G0 Note: The term "tax resident" means any person (e.g. an enterprise or individual) who, under the domestic tax law of a contracting party to the tax treaty, shall be regarded as a resid<kent. If the non-resident taxpayer is not a resident of the other contracting party to the tax treaty, he/she shall not be entitled to the treatment under the tax treaty.E E EM  7  b(XfN NHTbNyw[0Qnx0e0 I hereby declare that the information given above is true, accurate and error-free. ^E\l~zN~{zb~{W[ t^ g e Seal or signature of the non-resident taxpayer Y M DE |E E E E  7 mQ0,ghǑ(u-NeS6R\O Y-Neh NN N-NeNQ0Yeyr+Rf ^O(u-NekXQ0 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 be completed in Chinese.EE E.  7I N0,ghThkXQY N VII. Instructions on how to fill in each item are as follows:EE  7` N cb4INRNW,gOo`EE 7A N ^E\l~zNW,gOo` (II). Basic Information of Non-resident TaxpayerE  7?  N cb4INRNO(uOo` (III). Information for Use by Withholding AgentEE ?  7< V zR:gsQ{tO(uOo` (IV). Information for Use by Tax AuthoritiesEE  7 N Yl (V). Additional NotesEE  7 AQuestion 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 as prescribed in the domestic law of the resident state (region). If the non-resident taxpayer has enjoyed a tax reduction or exemption in the resident state, quote the name of the law, number of relevant clauses, and quote provisions that form the basis for such reduction or exemption. Note "N/A" if the non-resident taxpayer did not enjoy any reduction or exemption in the resident state (region). 7 mQ Xf (VI). DeclarationEE  79 Steg t^ g e Date of case acceptance: Y M DE E E E  7 kQ0-NVzR:gsQ\[^E\l~zNcNvOo`DeO[0EE 7VIII. Any information and materials provided by the non-resident taxpayer will be kept confidential by China s tax authorities. 7j. 1 6.k9 ; FNa| .Z cc  0>  dMbP?_*+% ,{ &P u qQ &N u&x@nd ---B++####!!"" !!""     && **''****(((())))))  $$(( %%7ggD&T(d  +!"  dMbP?_*+%; ,{ &P u qQ &N u&x < J = W X Y  ! #  Z ? $ % @ [ A S B K \ C & D ' E (D@l @!@"@#t@$@%@&*@'@(@)@*@ F !^ "G #N $] %" &H '_ () )a *bv>@sd 7ggD&T( DocumentSummaryInformation8HCompObj j˰վϢ ˵˵!Print_Area  Χ FMicrosoft Office Excel Biff8Excel.Sheet.89q