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Heading 1@ Heading 2A Heading 3B Heading 4 CInputD Linked Cell ENeutral FNormal 3 GNote HOutput ITitle JTotalK Warning TextL Mh Nh 1 Oh 2 Ph 3 Qh 4R]SS'8^ĉ_ 0^E\lON@b_zt^^~z3ubh 0(uNnc[3ubON (u~ĉkz6eOS[_Gv^E\l~zN kXQvcbcc g,gONCgv0R10%N NvN`Q9hnc^E\l~zN3ubNSz6eOS[_GevN`QkXQ0 7 10.7 ^E\l~zNlQ0WV[b0W:S kXQ^E\l~zNlQ{vvrzz6e{:S Ty0Y^E\l~zN(W/n0olQ{v ^kXQ /nyr+RL?e:S b oyr+RL?e:S 0^E\l~zN[E{t:gg@b(W0WV[b0W:S 0^E\l~zN;`:gg@b(W0WV[b0W:S _N^kXQvsQrzz6e{:S Ty0! 712.10 ^E\l~zNN-NVS_v@b_(WE\lV0W:S v~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 0 713.11 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 hQRf0 7 8.4 {f^E\l~zNgb~[ez6eE\lvN[`Q(Wdkh-NkXQ^E\l~zN&{TNSOS[v~[eV[b0W:S VQgbz6eE\lvl_hQvwQSON[0OY~[eVQlǑSlQ0WhQ$R[z6eE\lv ^E\l~zN^fONlQ0W0lQeI{lQ`Q0! 7e 7.3 _^E\l~zNgb~[ez6eE\lv~[eVQl_OnckXQ~[eV[b0W:S YUO[INT$R[vQz6eE\lvVQl_age0Qfl_age@b^\l_lĉ TyTag>k^S v^_vsQl_age0! 7 6.1 ^E\l~zN(W~[ev~~{|W wQ grz~z0WMOv%)R[SO T NwQ grz~z0WMOv%)R[SO c^E\l~zN/f&T(W~[eUSr4~^\NOS[(uVv@b_z$R[0~~{|W b vQN v {kXQ2 {f^E\l~zNv~~{|W0wQSOyr_T'`(0! 7-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. 7IV.  Information for use by withholding agent in Part III 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.  7>VII. Instructions on how to fill in each item are as follows:  7Name of non-resident taxpayer in resident state (region): Fill in the full English name of the non-resident taxpayer which is used in the non-resident taxpayer s state (region) of residence. 7Resident 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 appropriate. 7  Question 1,  The organization type of the non-resident taxpayer in the other contracting party : Determine if the non-resident taxpayer is a "business entity with independent taxpayer status" or a "business entity without independent taxpayer status" based on whether it independently pays the taxes covered by the Agreement in the other contracting party. Answer Question 2 if the organization type is categorized as "Others". Briefly describe the organization type, characteristics and nature of the non-resident taxpayer. % " 7OQuestion 7,  Place of registration (state or region) : State the name of the independent tax jurisdiction where the non-resident taxpayer is registered. If registered in Hong Kong or Macau SAR, note "Hong Kong SAR" or "Macau SAR" as appropriate. It is the same in case of the place of effecitve management and the place of head office. 7Question 9,  For a non-resident enterprise claiming for the benefits under the Agreement's articles of dividends, interest, royalties or capital gains, please provide information of all shareholders holding directly or indirectly at least 10 per cent of rights and interests of the enterprise : Provide the latest information at the time of claiming for treatment under the Agreement. 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. 75 N0cb4INRNW,gOo` `!.Basic Information of Withholding Agent: $ A$ 7NV0,gh,{ NR cb4INRNO(uOo` (uN(Wnlcb4bc[cb4`Q N cb4INRN8h[^E\l~zN/f&T&{TNSOS[_GagNvQNR(uNzR:gsQǑƖ{tOo`0 7Question 4,  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 no< n-resident taxpayer qualifies as a tax resident of the other contracting state (region). For example, where the contracting party determines tax residency based on the place of registration, the non-resident taxpayer should provide information such as the place and time of registration, etc.  7p % z Tax refund" " 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 state to the tax treaty, shall be regarded as a resident. If the non-resident taxpayer is not a resident of the other contracting party to the tax treaty, it shall not be entitled to the treatment under the tax treaty.="=" =M" 7I. This form is applicable to non-resident enterprise 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. 7oQuestion 3,  Please cite the domestic legal basis based on which the non-resident taxpayer qualifies as a tax resident of the other contracting party : Cite the provisions of the domestic law of the other contracting state (region) on how to define and determine tax residency. Specify the name of the law, the number of the relevant clauses, and specific provisions. 73Question 10,  Information of taxes paid in the resident state (or region) on the income derived from China : Specify the statutory tax rate as prescribed in the domestic law of the resident state (region). If the non-resident taxpayer has enjoyed tax reduction or exemption in the resident state (region), quote the name of the relevant law, the number of relevant clauses, and specific 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). 7m 1^E\l~zN(W~[ev~~{|W0 The organization type of the non-resident taxpayer in the other contracting party000="j= 7Y *2^E\l~zN(W~[ev~~{|WY:N vQN f Please explain if the answer to Question 1 is "others".="="=" 7 3_^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: @"" 7 4{f^E\l~zNgb~[ez6eE\lvN[`Q Please briefly describe the facts based on which the non-resident taxpayer qualifies as a tax resident of the other contracting party:@" 7@? 7^E\l~zNvlQ0WV[b0W:S Place of registration (state or region)@" 7 8{f^E\l~zN(WE\lV0W:S v;N~%;mRQ[0 Please briefly describe the main business activities of the non-resident taxpayer in the resident state (region).@ " 7@ 10^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)@/" 7" 119hnc,{ NV0W:S l_ĉ[ ^E\l~zN Te؏gbTNV[0W:S vz6eE\lmSY*NV[b0W:ShQRf  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).@;" 7 69hnc 0-NNSNlqQTVON@b_zl 0ĉ[,Ol(W-NVXQbz bOgqYV0W:S l_bzFO[E{t:gg(W-NVXQvON/f-NVvz6eE\l09hncl_ĉ[ ^E\l~zN/f&Tgb-NVvz6eE\l The Enterprise Income Tax Law prescribes that a resident enterprise refers to an enterprise that is established within the territory of China pursuant to Chinese laws or an enterprise that is established within the territory of another country or region pursuant to that country or that region's laws whose place of effective management is located in China. According to such provision, is the taxpayer a tax resident of China?@"@a" 7  % wQ grz~z0WMOv%)R[SO Business entity with independent taxpayer status % NwQ grz~z0WMOv%)R[SO Business entity without independent taxpayer status % ?e^ Government % ^%)R~~ Non-profit organization % vQN Others ="="L=M"O=^"="="="="="=" 7   % /f Yes % &T No"="  "=" 7 ` *9NSz6eOS[o`0)Ro`0< yrCgO(u90"N6evag>kz6eOS[_Gv^E\l~zN kXQvcbcc g,gONCgv0R10%N NvN`QhQRf For a non-resident enterprise claiming tax treaty benefits under the article of dividends, interest, royalties or capital gains, please provide information of all shareholders holding directly or indirectly at least 10 per cent of rights and interests of the enterprise.@<"?@N" 7 . III Information for Use by Withholding Agent "" 7 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. 7- mQ0,ghǑ(u-NeS6R\O Y-Neh NN N-Ne:NQ0Yeyr+Rf ^O(u-NekXQ0E 7 6 5Xf Declaration: b(Xf b:NNSz6eOS[~[ez6eE\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 D@"@N",@7"@"@"@" 7@% V. The non-resident taxpayer shall provide accurate and complete information to answer the questions contained in the form. Please write  N/A in the form if a situation described in a question is not applicable for a non-resident taxpayer. For a multiple-choice question, please mark  " in a corresponding box ( % ) or circle ( % ) for a choice that fits a non-resident taxpayer s situation. If a non-resident taxpayer s situation falls into the description of a question marked with  * , answers shall be provided; otherwise, it can be skipped.@ ";@<"K@L" 7~ Instructions for Filling out the Information Reporting Form of Tax Residence Status of Non-resident Taxpayer (for Enterprises) '! 7i+(IV) Information for Use by Tax Authorities 7  b(XfN NHTbNyw[0Qnx0e0 I hereby declare that the information given above is true, accurate and error-free. ^E\l~zN~{z Seal of non-resident taxpayer t^ g e NhN~{W[ Signature of the representative Y M D @ "n {@ " @ @ @ @ "* ["t  7II. This form can be used for self-declaration 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 submitted 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 s China sourced income is subject to withholding tax, administered at source or by means of a designated withholding 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 withholding agent and another is to be kept by the non-resident taxpayer. 7 Question 11,  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 party based on the laws of that third state (region), specify the name of that state (region). If more than one states (regions) are relevant, please specify all of them.%" 7%kQ0-NVzR:gsQ\[^E\l~zNcNvOo`DeO[0 7VIII. Any information and materials provided by the non-resident taxpayer will be kept confidential by China s tax authorities. 7  *12^E\l~zNNSvz6eOS[YS+T )RvP6R ag>kb NSOS[O`vDk {f^E\l~zN/f&T&{TvsQag>kBl0 If the treaty contains provisions of "Limitation on Benefits" or "Entitlement to <Benefits", please briefly describe whether the non-resident taxpayer meets the requirements of these provisions.@"@"@"@*"+@E" 75 9.5 Xf1u^E\l~zNvl[NhNbvQcCgNh#N~{W[v^/bRvONlQz v^kXQ~{W[S_eeg0!"+! 7The declaration shall be sealed by the non-resident taxpayer, and/or signed by the legal representative or authorized representative of the non-resident enterprise, and the date of the statement shall be provided. C7Question 5,  Declaration : Declaration should be signed and dated by the legal representative or the designated person of the non-resident taxpayer, and/or sealed by the non-resident taxpayer. 7P' )h,0Z 46:2>@~BHoPy n_qn|Ƌ5cc  3  dMbP?_*+%, ! ,{ &P u qQ &N u&x$@dn&&&BH''""++##!!--  ----//%%%%##**$$$$"" ..(())&&..,,,,,,..&&     7ggD&T(dj  @D   dMbP?_*+%&: ,{ &P u qQ &N u&x }nD@l x!x"x#x$x%(x&vx'vx(w@)w@*x+x,9x-x.x/{x0x1x2h@3h@4vx5fx6h@7h@8hx9vx:@;@>? P !{V "O #{` $N %{\ &{ '{} (}@ )yt *K +{W ,J -{X .L /{a 0M 1{w 2w 3y 4z 5{Y 6yA 7y 8; 9| :tx ;uy>q?q@D >0@dd888@S7ggD&\( DocumentSummaryInformation8PCompObj jϢ ˵"ҵ˰վϢ!Print_Area˵!Print_Area  Χ FMicrosoft Office Excel Biff8Excel.Sheet.89q