ࡱ> d  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcefghijklmnopqrstuvwxyz{|}~Root Entry F`x @WorkbookOle SummaryInformation( Oh+'0HPhx Wendy WD ZhangMicrosoft Excel@@ So@ ՜.+,0 PXx  PricewaterhouseCoopers \p _~t Ba== x-"8X@"1Calibri1Calibri1Calibri1Calibri1.Times New Roman1.Times New Roman1.Times New Roman1[SO1Arial1[SO1.Times New Roman1[SO1.Times New Roman1.Times New Roman1.Times New Roman1.Times New Roman1[SO1.Times New Roman1Calibri1h8Cambria1,8Calibri18Calibri18Calibri1Calibri1Calibri1<Calibri1>Calibri1?Calibri14Calibri14Calibri1 Calibri1 Calibri1Calibri1Calibri1 Calibri1[SO1[SO1 [SO1h8[SO1,8[SO18[SO18[SO1[SO1[SO1[SO14[SO1 [SO1[SO1 [SO14[SO1<[SO1?[SO1>[SO1[SO1[SO1[SO1[SO1[SO1[SO1[SO1[SO1[SO1. 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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~ĉkXhfVV  ;k" 17.28 Yg^E\l~zNVlbSN gb/gO(uCg S_yrCgO(u9 VT{N N,{2 T3 ~T^E\l~zNNSz6eOS[v 8^:gg ag>k gsQĉ[kXQb$Re0Yg^E\l~zN(W-NVgb8^:gg R gRRv@b_^(uz6eOS[%N)Rmag>kvĉ[ NNSyrCgO(u9ag>kvz6eOS[_G0 $7kQ0-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 40^E\l~zNL bcOvYfvQ&{TNSOS[_GvvQNDenUS List of other documents provided by the non-resident taxpayer on a voluntary basis to justify entitlement to tax treaty benefits;% $7@ 41^E\l~zNNMR]cN dk!kSNMQN͑ YcNvDenUSTcNe List of documents submitted before (and need not to be resubmitted) / Date of previous submission;$ $7@ N0,ghS(uNL3ubbcb43ub _NS(uN^E\l~zN3uz0^E\l~zNL3ubNSOS[_Gb3uzv ^kXQ,ghN_$NN NN(W3ubNSOS[_Gb3uzeN;N{zR:gsQ NN1u^E\l~zNYuX[[^E\l~zNegnN-NVv@b_[enlcb4bc[cb4{tv ^E\l~zNYNSz6eOS[_G ^kXQ,ghN_ NN NNN1ucb4INRN(Wcb43ubeN;N{zR:gsQ NN1ucb4INRNYuX[Yg NN1u^E\l~zNYuX[0= = $7 1^E\l~zN{|W Type of non-resident taxpayer 1 %?e^0?e^:gg Government or governmental body 2 %z6eOS[~[e?e^vcbcb g\20%Nv~[eE\llQS 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 %z6eOS[~[e?e^vcbchQb gD,gvvQN[SO Other entity with all its capital held by the government of the other tax treaty contracting party, whether directly or indirectly 4 %vQNlQS Other companies 5 %TOON Partnership enterprises 6 %vQN~~{|W f Please specify_____________________________________________ Other types of entity ; /;01;:n;op;;\;]^;z;;>;?@;Fr;st;|;; $7 6^E\l~zN{|W Type of non-resident taxpayer 1 %z6eOS[~[ev?e^0L?e:S00WeS_@\ Government, political subdivision, local authority of the other tax treaty contracting party 2 %z6eOS[~[e-N.YL Central Bank of the other tax treaty contracting party 3 %L Bank 4 %vQNё:gg Other financial institution 5 %vQNONb~~ Other business or organization; /;01;49G99990;12;:i;jk;u $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.  $7J  N0,gh,{NR1ucb4INRNkXQ Y^E\l~zNL3ub~zRekXQ0,ghvQYOR1u^E\l~zNkXQ0^E\l~zNkXb,gheS9hncXRDu0= = $7 Question 18,  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? : If a non-resident taxpayer earns the income from dividends, and fits the situation described in the question, Question 29 to 34 can be skipped, but the name of the stock exchange on which the company is listed and its stock code in Question 19 shall be provided.  $7 Question 23,  Please give a brief account of the contract(s) entered into between the non-resident taxpayer and the third party. : Please identify the third party and provide information with regard to the relationship between the third party and the non-resident taxpayer, such contract informati< on as the amount, interest rate, duration, date of signature, interest-paying and repayment terms and guarantor, as well as the relationship between the contract(s) and the income to be considered for tax treaty benefits. Qz  $7'  Question 28,  Where the non-resident taxpayer has transferred or licensed the right to use know-how and derives royalties therefrom, please answer the following questions. : In answering Question (2) and (3), please make judgment based on the tax treaty terms concerning a non-resident  permanent establishment . If the non-resident taxpayer operates through a permanent establishment in China, the service income shall be subject to the business profits article of the tax treaty, and will not enjoy tax treaty benefits under the royalties article. F  $7] I. This form is applicable to non-resident enterprise income taxpayer who receives dividends, interest or royalties sourced in China, and claims tax treaty benefits under the article of dividends, interest or royalties of a Double Taxation Agreement (DTA) signed by China (including the DTAs with Hong Kong and Macau Special Administrative Regions).'H  $7Question 15,  Statement by non-resident taxpayer as the  beneficial owner of the income :  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? shall be answered based on whether the non-resident taxpayer can dispose of the income-earning property or rights, or the income itself, at its own discretion (namely, exercising control or disposal rights free of the influence of any related or non-related parties).  Does non-resident taxpayer bear the risks associated with the income or the property or rights from which such income derives? shall be evaluated based on whether the non-resident taxpayer must bear the losses arising from uncertainties impacting on the income-earning property or rights and on the income itself; if the non-resident taxpayer seldom bears such risks or the income and risks do not match,  No shall be selected. $7  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? shall be honestly answered by a non-resident taxpayer based on whether an arrangement without a reasonable commercial purpose is used to gain tax treaty benefits, abuse a tax treaty and/or reduce or avoid the non-resident taxpayer s tax-paying duties in China. A non-resident taxpayer shall make a statement concerning its identity as the beneficial owner and shall be held accountable under relevant tax law for tax avoidance and other violations arising from an untrue statement.I V0,gh,{ NR cb4INRNO(uOo` (uN(Wnlcb4`Q N cb4INRN8h[^E\l~zN/f&T&{TNSOS[_GagNvQNR(uNzR:gsQǑƖ{tOo`0= = = $7$ 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 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 N cb4INRNW,gOo`=  $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. $7t7.8 7>kDё/f&TX[(WN N`Q^E\l~zNNSvz6eOS[)Ro`ag>k gvsQP6R'`ĉ[ N^E\l~zNOncĉ[NSz6eOS[_Gv {kXQdk0^E\l~zNkXQdkT{(W9-NQf&{TagNv?e^b:gghQy0vQN`QekXQ0 $7h 8.12 {cncNNuyrCgO(u9@b_vwQSOCg)Rb"N[ncNNuyrCgO(u9@b_vCg)Rb"Nv{|WۏLwQSOf Y^\NUOyN)R0W\OCg yAUOyYI{0v^fyrCgO(u9v/eNagNT{hQ0>  $79.13 y@b_/f&TN^E\l~zN(W-NVv8^:ggbV[W0W g[ET|8^:gg/fc^E\lONb*NN(W-NVۏLhQbR%NvV[%N:W@b0V[W0W/fcNNrz*NNRR;mRvNXTNNvQNR;mRvV[:W@b0Wp 0Yy@b_N^E\l~zN(W-NVv8^:ggbV[W0W g[ET| Ry@b_^~eQ8^:ggv%N)Rm_z b~eQrz*NNRR@b__z NNSo`0)Ro`byrCgO(u9ag>kz6eOS[_G0 $710.14 ^E\l~zN/f&TǏNtNS_y@b_NtNSbc[6e>kN0Y^E\l~zN/fǏNtNS_y@b_ (W3ubNSz6eOS[_GeT;N{zR:gsQcNNtN NwQ gSv@b gNNvXf0Y^E\l~zNǏYXbbDS_y@b_ (W3ubNSz6eOS[_GeT;N{zR:gsQcN 0V[zR;`@\sQNYXbbD`Q N[Sv@b gNvlQJT 0V[zR;`@\lQJT2014t^,{24S ĉ[vbJTDe0 $712.16 NSz6eOS[< _GvO`zsb[E_6es kXQNSz6eOS[_GvO`zs0Yz6eOS[ĉ[NyrCgO(u9;`v70%:NWpe RkXQ[E_6es:N7% Yz6eOS[ĉ[[y@b_MQz RkXQ[E_6es:N00^E\l~zN@bkXO`zsb[E_6es {N~z3ubhbcb43ubhOcN0 $715.23 {f^E\l~zNN,{ NNKNT T`Qf,{ NNNS,{ NNN^E\l~zNKNvsQTsQ| ^E\l~zNN,{ NNKNT Tvpe0)Rs0gP0~{e0No`N؏>kagN0bONI{T T } NST TNNSz6eOS[_Gvy@b_KNvT|0 $716.27 {f^E\l~zNN,{ NNKNT T`Qf,{ NNNS,{ NNN^E\l~zNKNvsQTsQ| ^E\l~zNN,{ NNKNT Tvpe0~{e0 gHegP0l gsQO(uCgb@b gCgvagN06e9e_I{T T } NST TNNSz6eOS[_Gvy@b_KNvT|0 $7U18.34 {[@b_ۏL NYtvt1uY[kXQۏLYt/fQNUOyFUNvvbQ ^E\l~zN/f&T1\dkYt~{ gNUOT Tb[c ^E\l~zNT6e>kevsQ|I{0 $7}Question 12,  Please give a brief description of the specific right or property from which the royalty income derives. : Please provide specific details of the rights or property from which the royalty income derives, such as the type of the patent, copyright and equipment leased. Information about the payment terms and calculation basis of the royalties shall also be provided.  $7VQuestion 13,  Is the income effectively connected with a permanent establishment or fixed base of the non-resident taxpayer in China? : A permanent establishment refers to a fixed place of business through which the business of a non-resident enterprise or individual is wholly or partly carried on in China. A fixed base refers to a fixed place (location) through which an individual engaging in independent personal services conducts his or her business activities. If the income is effectively connected with a permanent establishment or a fixed base of a non-resident taxpayer in China, the income shall be taxed as part of the profits of the permanent establishment, or as part of the individual s income from independent personal services, and may not be deemed eligible for tax treaty benefits under the dividends, interest or royalties articles.  $7 >Question 14,  Did the non-resident taxpayer receive the income via an agent? : An agent includes a designated payee. If the income was received by a non-resident taxpayer through an agent, the non-resident taxpayer shall submit a statement to the in-charge tax authority, at the time of filing for tax treaty benefits, confirming that the agent does not act in the capacity of a beneficial owner. If the non-resident taxpayer receives the income through an entrusted investment arrangement, the non-resident taxpayer shall submit to in-charge tax authority, at the time of filing for tax treaty benefits, reporting materials as required by the Announcement of the State Administration of Taxation on Identifying a Beneficial Owner under an Entrusted Investment (Announcement of the State Administration of Taxation No. 24, 2014).  $7Question 16,  Preferential tax rate under tax treaty treatment (or actual tax rate) : Fill in the preferential tax rate applying under the tax treaty. If the tax treaty prescribes that 70% of the total royalties shall be used as a base, write 7% as the actual tax rate; if the tax treaty grants a tax exemption on the income, write 0 as the actual tax rate. The preferential tax rate (or actual tax rate) filled in by a non-resident taxpayer shall match that on the Tax Filing Form or Withholding Declaration Form. $7~14.18 ^E\l~zN/f&T:Nz6eOS[~[eE\lN(W~[e N^vlQS100%vcbcb gY^E\l~zNS_v/fo`@b_ N^E\l~zN&{T@bagN R^E\l~zNekXQ29-34 FO{kXQ19 N^8RNf@b TyT N^hyNx0 $7zQuestion 17,  Is non-resident taxpayer a listed company in a tax treaty contracting party state? : If the non-resident taxpayer earns the income from dividends, and is a listed company in a tax treaty contracting party state, Question 29 to 34 can be skipped, but the name of the stock exchange on which the company is listed and its stock code in Question 19 shall be provided. $7q13.17 ^E\l~zN/f&T:Nz6eOS[~[ev N^lQSY^E\l~zNS_v/fo`@b_ N^E\l~zN/fz6eOS[~[e N^vlQS R^E\l~zNekXQ29-34 FO{kXQ19 N^8RNf@b TyT N^hyNx0 $7Question 34,  Please briefly account for the above treatment of the income. : Please provide a true account of the commercial purposes or considerations behind these arrangements, and such information as whether the non-resident taxpayer has entered into any contracts or arrangements underpinning these pay< ment/distribution arrangements and the relationship between the non-resident taxpayer and the recipient. $719.37 ^E\l~zNя Nt^/f&T gegnN-NVXQvQN0W:Sv T{|@b_Yg^E\l~zNя Nt^(W-NVvQN0W:SS_ T{|@b_ S N T;N{zR:gsQ{t ^ b /f v^kXQ380390(W39-NRf^E\l~zNя Nt^1\egnN-NVXQvQN0W:Sv@b g T{|@b_NSz6eOS[_G`Q SSDfDe0 $7Question 37,  Has the non-resident taxpayer received any income of the same type sourced in other regions within China over the past three years? : If the non-resident taxpayer has any income of the same type sourced in other regions within China over the past three years, and this is under the jurisdiction of a different in-charge tax authority,  Yes shall be selected, and Question 38 and 39 shall be answered. Please specify all tax treaty benefits claimed by the non-resident taxpayer for any income of the same type sourced in other regions within China over the past three years in Question 39. Supporting materials can be attached separately. $7Non-resident taxpayer can provide, on a voluntary basis, other materials to justify the non-resident taxpayer s entitlement to the tax treaty benefits. When providing such materials, please identify all of them on the list.  $7;Non-resident taxpayer can provide other information that the non-resident taxpayer believes should be considered by the in-charge tax authority and may be beneficial to justify the non-resident taxpayer s entitlement to the tax treaty benefits. Please specify the special situations in the additional notes, if any. $7b ^E\l~zN(WE\lV0W:S ~zNƋ+RS Tax identification number of non-resident taxpayer in resident state (region)9 $7@M N NSo`ag>k_G (I) Claiming Tax Treaty Benefits under the Article of Dividends8  $7M N NS)Ro`ag>k_G (II) Claiming Tax Treaty Benefits under the Article of Interest8  $7@T  N NSyrCgO(u9ag>k_G (III) Claiming Tax Treaty Benefits under the Article of Royalties8 $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 ;|;;;;; $7;b N0,gh(uNS_egnNbVvo`0)Ro`0yrCgO(u9@b_ NSbV[Y~{rvMQS͑_zOS[+TN/noMQS͑_z[c -No`0)Ro`0yrCgO(u9ag>kvz6eOS[_GvON@b_z^E\l~zN0  $7 N ^E\l~zNW,gOo`6 $7$ 1.cb4INRN Ty1ucb4INRNkXQzR{v@b}cb4INRNvhQy0  $7@H5.@b_{|W^E\l~zN9hncS_@b_v[E{|W b0,{ N0VRNkXQ1\@b {|W@b_NSz6eOS[_GvsQvv S vQNOo` -NvqQ'`v0 $7*4.^E\l~zN(WE\lV0W:S TykXQ^E\l~zN(WvQE\lV0W:S vehQy0 $711.15 ^E\l~zN:Ny@b_v Sv@b gN vXf ^E\l~zN/f&T[@b_b@b_ncNNuv"NbCg)RwQ gc6RCgbYnCg 9hnc^E\l~zN[@b_ncNNuv"NbCg)RT@b_,g/f&TSNOꁫa?a/eMsSLOc6RCgbYnCg NSNUOsQTb^sQTv,{ Neq_T ۏL$Re0 ^E\l~zN/f&T[@b_b@b_ncNNuv"NbCg)Rbbv^Θi 9hnc^E\l~zN/f&Tbb@b_ncNNuv"NbCg)RT@b_,gVTy Nnx[V } mSv_c1YۏL$Re Yg^E\l~zN_\bbΘib@b_TΘi N9SM _N^ b &T 0 ^E\l~zNncNS_y@b_v gsQCg)Rb"N/f&T:N_z6eOS[vQMQz)Rv [c ^E\l~zN^Y[VT{/f&TX[(WǏ NwQTtFUNvv[c_z6eOS[)Rv0n(uz6eOS[0Q\b^E\l~zN(W-NV~zINRv`b_0^E\l~zN[ꁫvSv@b gNNۏLXf VNXf N&{ QsvzI{\ cgqvsQz6el_ĉ[ۏLYt0 $7 N DbDenUS  $7 mQ Yl  $7 N Xf  $7M kXheg t^ g e Date of filing: Y M D999 9" $7R 3ubeg t^ g e Date of filing: Y M D0999!9#Q9 $7H Steg t^ g e Date of case acceptance: Y M D999"9$ $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. $7  % L3ub % cb43ub % z Self-declaration Withholding declaration Tax refund99 -9./93R9ST9W $7>VII. Instructions on how to fill in each item are as follows:  $7NSz6eOS[o`0)Ro`0yrCgO(u9ag>k_G(u  $7V(Applicable to Tax Treaty Benefits under Articles of Dividends, Interest or Royalties) $70 2.cb4INRN~zNƋ+RS1ucb4INRNkXQcb4INRNzR{v Nlfv ~zNƋ+RS 0 ' ( . /  $7 N0,ghThkXQY N, (I) Basic Information of Withholding Agent! (V) List of documents attached (VI) Additional Notes(VII) DeclarationkXhf{Name of withhold< ing agent: The withholding agent should provide its full name as shown in its tax registration certificate.Tax identification number of withholding agent: The withholding agent should provide its identification number as shown in the tax registration certificate.  3 NNtvsQvΘiT6ev/f&T1u^E\l~zNbb Does the non-resident taxpayer assume the risks and enjoy the benefits in relation to the assets held and income passing via the agent?0III. 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. IV.  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. pChinese name of non-resident taxpayer: Fill in the full Chinese name used by the non-resident taxpayer in China. *23{f^E\l~zNN,{ NNKNT T`QSb,{ NN Ty0,{ NNN^E\l~zNvsQ|0T T~{~eg0ё0gP0)Rs0No`N؏>kagN0bONI{ 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.).;N $72 35~[eV[0W:S [dky@b_vzRYt`Q Tax treatment of the income in the other contracting party % N_z %MQz %_zzs\NI{N12.5% %vQN Not liable to tax Exempt Tax rate less than or equal to 12.5% Others 9_9cy9|99 $7 Instructions for Filling out the Reporting Form for Non-resident Taxpayer Claiming Tax Treaty Benefits (Form A for Enterprise Income Tax)q@ $7 6 Question 27,  Please give a brief account of the contract(s) entered into between the non-resident taxpayer and the third party. : Please identify the third party and provide information with regard to the relationship between the third party and the non-resident taxpayer, such contract information as the amount, date of signature, duration of contract, and the conditions and charging method on which relevant ownership or right of use is transferred, as well as the relationship between the contract(s) and the income to be considered for tax treaty benefits. 1  $7 ^E\l~zNNSz6eOS[_G`QbJThON@b_zAh Reporting Form for Non-resident Taxpayer Claiming Tax Treaty Benefits (Form A for Enterprise Income Tax)@ $7 1 ^E\l~zN/f&T>mNXT:Nyb/gvO(ucO gsQ/ec0c[I{ gRv^6eS gR9 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? 99* $7% 2 ^E\l~zN>mcNXT(W-NV:Nyb/gvO(ucO gsQ/ec0c[I{ gRޏ~b/}c~vegpeb)Ype 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)996 $7 3 ^E\l~zN>mNXT:Nyb/gvO(ucO gsQ/ec0c[I{ gR/f&T]gb(W-NVv8^:gg 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? 990 $7/(II) Basic Information of Non-resident Taxpayer $7  N cb4INRNO(uOo`:  $7:/ (III) Information for Use by Withholding Agent $7 V zR:gsQ{tǑƖOo`  $7 , (IV) Information for Use by Tax Authorities $7r6.4 ^E\l~zNvcbcb g/eNo`lQSvNkOTT^E\l~zN(WlQSvbDё^E\l~zNNSvz6eOS[o`ag>k gvsQP6R'`ĉ[v ^E\l~zN{kXQdk vQ-N^y^kXQz6eOS[Rf^y0vQN`QekXQ0 $7 Type of income: The non-resident taxpayer should select the type of income actually received; In Part III and Part IV one should only fill in items related to enjoying tax treaty benefits for the selected type of income, and for those common items in  Other information .<Question 4,  Percentage of total share capital held, directly and indirectly, by the non-resident taxpayer in the dividend paying company and  Amount of investment in the dividend paying company by the non-resident taxpayer : If the dividend article of the tax treaty, which the non-resident taxpayer is entitled to<  enjoy, contains such a limiting condition then the non-resident taxpayer should answer this question; for  Currency , the currency specified in the tax treaty shall be filled in. In circumstances where these questions are not relevant they can be skipped.Question 8,  Do any of the following circumstances apply in respect of the loaned monies? : If the interest article of the tax treaty, which the non-resident taxpayer is entitled to enjoy, contains such a limiting condition, and the non-resident taxpayer in accordance with this condition is entitled to treaty benefits, then the non-resident taxpayer should answer this question. The non-resident taxpayer shall provide the full name of the government or institution, where the loan circumstances accord with the terms of the treaty relief, in Question 9 that follows. In circumstances where these questions are not relevant they can be skipped. 0^E\l~zNNSz6eOS[_G`QbJThON@b_zAh 0N0^E\l~zN^Y[[tekXQ,gh@bR0Y^E\l~zNl g@bR`Q (Whk_G(u (Applicable to Tax Treaty Benefits under Articles of Dividends, Interest or Royalties)8 $7; kXheg t^ g e Filling date: Y M D 9 9 99 $7 '^USMOCQNl^ Currency unit: RMB9 5 N0cb4INRNW,gOo` I. Basic Information of Withholding Agent8 ! cb4INRN Ty Name of withholding agent9: cb4INRN~zNƋ+RS Tax identification number of withholding agent9  $71 ^E\l~zN-Ne Ty Chinese name of non-resident taxpayer 9 M ^E\l~zN(W-NVv~zNƋ+RS Tax identification number of non-resident taxpayer in China 9J ^E\l~zN(WE\lV0W:S v Ty Name of non-resident taxpayer in resident state (region)90 ^E\l~zNNSz6eOS[ Ty Name of the applicable tax treaty9 @b_{|W Type of income9B % o` Dividends % )Ro` Interest % yrCgO(u9 Royalties99990912989  N0cb4INRNO(uOo` III. Information for Use by Withholding Agent8  $7M N NSo`ag>k_G (I) Claiming Tax Treaty Benefits under the Article of Dividends8  ё Amount:9 ^y Currency:9M N NS)Ro`ag>k_G (II) Claiming Tax Treaty Benefits under the Article of Interest8   % /f Yes % &T No99  % /f Yes % &T No9999 V vQNOo` (IV) Other Information87 V0zR:gsQ{tǑƖOo` IV. Information for Use by Tax Authorities8  $7  N^hyNx Stock code96  Tg^:W)Rs Market interest rate of the same period9   ؏>kagN Repayment terms9 lQD,g Registered capital:9, {t9(uё General and administrative expenses:9 cN9ё Directors' fees:9 e Time:9 0Wp Location:9 6e>ke Ty Name of recipient9/ 6e>keE\lV0W:S Resident state (region) of recipient9  /eNkO Payment percentage9 /eNe Time of payment9  4 {fNtsQ|SevCg)RTINR0 Please give a brief account of the right and obligations of both parties in the agency relationship.99 ;N{zR:gsQ In-charge tax authority9 e(t^N) Time (year)99 @b_ё Amount of income9* QMQzё Amount of tax reduction or exemption9 1 99 2 99 3 99 4 99 5 99& N0DbDenUS V. List of Documents Attached8 cNe Submission date9 $7 mQ0Yl VI. Additional Notes8 N0Xf VII. Declaration8( cb4INRNlQz Seal of the withholding agent: 9  $7" Nt3ub-NN:gglQz Seal of the tax agent:9 ; ;N{zR:gsQStN(uz Dedicated seal of the in-charge tax authority:9  $7# ~RN Signature of the case handler:9 $7 StN Received by:9 V[zR;`@\v6R9 7  % /f Yes % &T No9999 $7 DN 3 Appendix 37 $7; N0^E\l~zNW,gOo` II. Basic Information of Non-resident Taxpayer8  $7h  ^E\l~zN(WlQSvbDё Amount of investment in the dividend paying company by the non-resident taxpayer; $7 26(WyrCgO(u9ncNNuT/eNvHrCg0N)R0b/gI{O(uCglT TKNY ^E\l~zNN,{ NNKN/f&TX[(W(W gsQHrCg0N)R0b/gvO(uCgb@b gCgebvlT T < 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? ;QR?S $7 - mQ0,ghǑ(u-NeS6R\O Y-Neh NN N-Ne:NQ0Yeyr+Rf ^O(u-NekXQ0  $7VI. 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. $7R  N NSyrCgO(u9ag>k_G (III) Claiming Tax Treaty Benefits under the Article of Royalties8< $7 1 ^E\l~zN/f&T[@b_b@b_ncNNuv"NbCg)RwQ gc6RCgbYnCg 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?99& $7 2 ^E\l~zN/f&T[@b_b@b_ncNNuv"NbCg)Rbbv^Θi Does the non-resident taxpayer bear the risks associated with the income or the property or rights from which such income derives?99# $7  3 ^E\l~zNncNS_y@b_v gsQCg)Rb"N/f&T:N_z6eOS[vQMQz)Rv [c 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?99- $7& 4 Xf Declaration: b(Xf b:Ny@b_vSv@b gN bS_y@b_v gsQCg)Rv^^:NN_z6eOS[)Rv [c0 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. ^E\l~zN~{zb~{W[ t^ g e Seal or signature of non-resident taxpayer Y M D99!9PF9Q999 $7<  % /f kXQ19 Yes. Please answer Question 19 % &T No999 596798 $7K  % /f (W NN-Nf Yes. Please specify in the next question % &T No999D9EG9H $7J  % /f (W NN-Nf Yes. Please specify in the next question % &T No999D9EF9G $7Q  % /f VT{ Nb$N*N Yes. Please answer the following two questions % &T No9;9J9KL;M $7O  % /f kXQ Nb2*N Yes. Please fill in the following two questions % &T No9;9  9I9JK;L $7'  1 NtN Ty Name of the agent99  $7S  2 NtN6e9hQTagN Standard service charge and terms of agency relationship99 $7w 2^E\l~zNvcb g/eNo`vlQSvNkO Direct shareholding percentage of the non-resident taxpayer in the dividend paying company; $7 3^E\l~zNvcb gNkO(WS_o`MRv12*NgQ/f&Tf gNON25% N+T25% v`Q 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?;;"%;(+;1 $7 *4^E\l~zNvcbcb g/eNo`lQSvNkOT Percentage of total share capital held, directly and indirectly, by the non-resident taxpayer in the dividend paying company; $7Q *87>kDё/f&TX[(WN N`Q Do any of the following circumstances apply in respect of the loaned monies? 1 %1uz6eOS[~[e&{TagNv?e^b:ggccODё 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 %1uz6eOS[~[e&{TagNv?e^b:ggcObO 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 %1uz6eOS[~[e&{TagNv?e^b:ggcOOi 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 treaty9d9ef9r9st9f9gh9 $7 *9Y7>kDё1uz6eOS[~[e&{TagNv?e^b:ggccODёbbObOi kXQ&{TagNv?e^b:gghQy Please provide the full name of the qualified government or institution if loans/funds, a guarantee or insurance are ind< irectly provided by a qualified government or institution of the other tax treaty contracting party98 $7- ]Dё;` Sum of employees' wages and salaries:9 $7 5^E\l~zN/f&T/fz6eOS[Rf)Ro`@b_MQz~~b:gg Is the non-resident taxpayer listed as an organization or institution specifically exempt from source country tax on interest in the tax treaty?; $7 7^E\l~zN/f&T[hQ:Nz6eOS[~[ev?e^@b g Is the non-resident taxpayer wholly-owned by the government of the other tax treaty contracting party?; $7* 10ncNNuyyrCgO(u9vCg)Rb"N^\NN NTy{|W To which of the following types of right or property do the royalties fall into? 1 %ef[0z/gbyf[W\O Literature, artistic or scientific work 2 %N)R0FUh00!jW0V~0y[Meby[ z^ Patent, trade mark, design, model, plan, secret formula or process 3 %]N0FUN0yf[Y Equipment for industrial, commercial or scientific use 4 % gsQ]N0FUN0yf[~vOo` Information concerning industrial, commercial and scientific experience 5 %vQNyrCgO(u9 Other royalties 9v9wx99939459B9999 $7x 11@b_/f&T^\Nޘ:g096yA@b/eNvyrCgO(u9 Is the income attributable to a royalty paid for aircraft leasing or ship chartering? 9 $7@ 12{cncNNuyrCgO(u9@b_vwQSOCg)Rb"N0 Please give a brief description of the specific right or property from which the royalty income derives.9" $7@ 13y@b_/f&TN^E\l~zN(W-NVv8^:ggbV[W0W g[ET| Is the income effectively connected with a permanent establishment or fixed base of the non-resident taxpayer in China?;% $79Z 14^E\l~zN/f&TǏNtNS_y@b_ Did the non-resident taxpayer receive the income via an agent?; $7 15^E\l~zN:Ny@b_v Sv@b gN vXf Statement by non-resident taxpayer as the "beneficial owner" of the income c:y Sv@b gN /fc[@b_b@b_ncNNuvCg)Rb"NwQ g@b gCgT/eMCgvN0Yg^E\l~zN N/fegnN-NVvo`0)Ro`byrCgO(u9@b_vSv@b gN R NNSz6eOS[_G0 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. ;;;n;qr;wx; $7b 16NSz6eOS[_GvO`zsb[E_6es Preferential tax rate under tax treaty treatment (or actual tax rate)9 $7t *17^E\l~zN/f&T:Nz6eOS[~[ev N^lQS Is non-resident taxpayer a listed company in the other tax treaty contracting party?; $7@) *19 N^8RNf@b Ty Name of the stock exchange 9  $7@ *18^E\l~zN/f&T:Nz6eOS[~[eE\lN(W~[e N^vlQS100%vcbcb g N+TǏ N^\N-NVE\lb~[eE\lv,{ NeV[b0W:SE\lONcc gNv`Q  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 )?;"&;Y $7~ 207>kT T)Rs Interest rate for loan contract 9  $7w 21^E\l~zNN)Ro`/eNNKN/f&T gsQTsQ| Is there any related party relationship between non-resident taxpayer and interest payer?; $7T 22(W)Ro`ncNNuT/eNv7>kT TKNY ^E\l~zNN,{ NNKN/f&TX[(W(Wpe0)RsT~{eI{ebvяvvQN7>kbX[>kT T? 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? ;? $7 24[ncNNuyrCgO(u9vCg)Rb"N ^E\l~zN/f&Tb gCg^\f?Y g SSDCg^\fPge0 Does the non-resident taxpayer have an ownership certificate with respect to the rights or property from which the royalties derive? If so, the copy of the certificate may be attached separately.;#$;2 $7x 25^E\l~zNNyrCgO(u9/eNNKN/f&T gsQTsQ| Is there a related party relationship between non-resident taxpayer and royalty payer?; $7@ *27{f^E\l~zNN,{ NNKNT T`QSb,{ NN Ty0,{ NNN^E\l~zNvsQ|0T T~{~eg0ё0gP0SO(uagN06e9e_I{ Please give<Q 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.).;K $7; *28Yg^E\l~zNVlbSN gb/gO(uCg S_yrCgO(u9 VT{ NR Where the non-resident taxpayer has transferred or licensed the right to use know-how and derives royalties therefrom, please answer the following questions;+ $7 29{fdc gy@b_ncNNuvCg)Rb"NY ^E\l~zNvvQN~%;mR`QTvQN"N`Q 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.;2 $7;d 30^E\l~zN NNOt^^"R`Q Financial position of the previous fiscal year of the non-resident taxpayer ; $7@] 31^E\l~zNgяN!k>NLcNO`Q Information on the non-resident taxpayer's most recent board meeting; $7@ 32^E\l~zN/f&T gINR(W6e0R@b_v12*NgQ\@b_vhQb~'YR60%N N /eNb>mS~,{ NV0W:S E\l? 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?;;%(;: $7; *33^E\l~zN(WS_y@b_Tv12*NgQ gINR[Y/eNb>mSv`Q Non-resident taxpayer is obligated to pay or distribute the income within 12 months after receipt ;;& $7Z *34{f[y@b_ۏL NYtvt1u Please briefly account for the above treatment of the income. 9 $7 *36Yg^E\l~zNǏNtNS_y@b_ kXQN N If the non-resident taxpayer receives the income through an agent, please fill in the following questions;  $7@ 37^E\l~zNя Nt^/f&T gegnN-NVXQvQN0W:Sv T{|@b_ Has the non-resident taxpayer received any income of the same type sourced in other regions within China over the past three years?;! $7 *38^E\l~zNя Nt^/f&T1\egnN-NVXQvQN0W:Sv T{|@b_NSǏz6eOS[_G 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?;* $7; *39f^E\l~zNя Nt^1\egnN-NVXQvQN0W:Sv T{|@b_NSz6eOS[_Gv`Q 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.;- $7\, =`9`ul 8 O uUAQqƿlIF mj^7FG+U7, cc   l|is  dMbP?_*+%,2 &2;HW ,{ &P u qQ &N u&x""8"88"."""6":"6"6""""6""6  @!@"(@#@$ @%@&@'@(@) @* @+@,@-@.@/@0D@1 @2@3@4H@5C@6i@7e@8@9@:@;@<O @=e@>e@?e@   ! ! !t! 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BP(?U} dm} $ mP@@@@@f@@@ @ @ @ @ @ 8@@@@h@h@h@Y@Y@X@h@X@h@h@h@h@h@@@ p\ z< zD qM {= s- r r r r rH r rI s] r   s? r;  |@ }/ }E }> }F . |S ^ }J 1 } 0D@l @!@"@#@$F@%@&@'@(t@)@*@+@,@- @.o @/@0@1@2w@3w@4@5@6@7@8@9F@:@;@< @= @>@?@ }Y !T "|U #X $}Z % &}[ ' (} ) *} + ,} -2 .} / 0 1} 2V 3|W 4" 5}! 6 7} 8 9} : ;}N < =} > ?}#D@l@)@A@B@C@D@E@F@G@H@I@J@K@L@M@N@Ov@ @$ A}% B3 C|A D_ E}& F4 G|B H` I}' J5 K|C La M9 Ns Or$ ,>@ssAAA$7ggD&\( DocumentSummaryInformation8LCompObj j ҵ˰A ˵ҵ˰A!Print_Area  Χ FMicrosoft Office Excel Biff8Excel.Sheet.89q