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B hB &! &&*|hB P#"5,0e,60E0 DN *NN@b_z~z3ubh (uNt^@b_12NCQN Nv~zN3ub INDIVIDUAL INCOME TAX RETURN (For individuals with an annual income of over 120,000 Yuan) @b_t^N: t^ kXheg t^ g e ёUSMO Nl^CQR҉R Year of income incurred: Date of filing: date month year Amount in RMB Yuan ~zNY T Tax payer s nameVM|(0W:S) Nationality /regionNgq{|W ID TypeNgq Sx ID numberNL0SǖUSMO EmployerNLSǖUSMOzRNx Employer s Tax ID CodeNLSǖUSMO @b^\LN Industry of EmployerLR TitleLN Profession(WNS)Ype Days of stay in ChinaXQ gHe T|0W@W Address in ChinaXQ gHeT|0W@W Post codeT|5u݋ Tel numberdkL1uS_~%@b_v~zNkXQ This line is to be filled by taxpayers with business income~%USMO ~zNƋ+RS Tax ID Code of the business~%USMO ~zN Ty Name of the business@b_yv Categories of incomet^@b_ Annual Income^~z@b_ Taxable income^~z Tax payable]4cb z Tax pre-paid and withheldbcbz Tax creditQMQz Tax exempted or deducted^ez Tax owed^z Tax refundableYl NotesXQ Income from within ChinaXY Income from outside ChinaT Total10]D0ё@b_ Wages and salaries20*NSO]FU7bvuN0~%@b_ Income from production or business operation conducted by self-employed industrial and commercial households30[ONNUSMOvbS~%0by~%@b_ Income from contracted or leased operation of enterprises or social service providers partly or wholly funded by state assets40RRbl@b_ Remuneration for providing services50?zl@b_ Author s remuneration60yrCgO(u9@b_ Royalties70)Ro`0o`0~)R@b_ Interest, dividends and bonuses80"NyA@b_ Income from lease of property90"Nl@b_Income from transfer of propertyvQ-Nhyl@b_ Income from transfer of stocks        *NN?bK\l@b_ Income from transfer of personal estate100vP6q@b_ Incidental income110vQN@b_ Other incomeT TotalbXf dk~z3ubh/f9hnc 0-NNSNlqQTV*NN@b_zl 0S gsQl_0lĉvĉ[kXbv bO[/fw[v0S`v0[tev0 Under penalties of perjury , I declare that this return has been filed according to THE INDIVIDUAL INCOME TAX LAW OF THE PEOPLE S REPUBLIC OF CHINA and other relevant laws and regulations, and to the best of my knowledge and belief. I guarantee the information provided is true, correct and complete. ~zN(~{W[) Taxpayer s signatureNtN (~{z): Preparer (Other than taxpayer) s firm T|5u݋:Phone numberzR:gsQStN~{W[  zR:gsQSte t^ g e St3ubzR:gsQ Tyvz  Signature of responsible tax officer : Filing date: Time: Year/Month/Date Responsible tax office kXh{w N0,gh9hnc 0-NNSNlqQTV*NN@b_zl 0SvQ[eagOT 0*NN@b_zL~z3ubRl(ՋL) 06R[ (uNt^@b_12NCQN N~zNvt^^L3ub0 N0 g~zINRv*NN SN1u,gNbYXbNNN~zt^^~NT3*NgNQT;N{zR:gsQb,gh0 N cgqĉ[gPb,ghe ^S_(Wĉ[vbgPQcQ3u ~S_0WzR:gsQybQ SNS_^g0 N0kXQ,gh^S_O(u-Ne _NSN Te(u-N0Y$NyeW[kXQ0 V0,ghThvkXQfY N 10@b_t^NTkXheg 3ub@b_t^NkXQ~zN[ES_@b_vt^^ kXheg kXQ~zNRt~z3ubv[Eeg0 20Ngq{|W kXQ~zNv gHeNgqE\lN0QNNN0bgq0VaNI{ Ty0 30NgqSx kXQ-NVE\l~zNv gHeNgq NvSx0 40NL0SǖUSMO kXQ~zNvNL0SǖUSMO Ty0~zN gY*NNL0SǖUSMOe kXQSt3ubvzR:gsQ;N{vNL0SǖUSMO0 50NL0SǖUSMOzRNx kXQSt3ubvNL0SǖUSMO(WzR:gsQRtzR{vbcb4{vvx0 60NL0SǖUSMO@b^\LN kXQSt3ubvNL0SǖUSMO@b^\vLN0vQ-N LN^ cVl~NmLNR{|hQkXQ N,kX'Y{|0 70LRkXQ~zN(WSt3ubvNL0SǖUSMO@bbNvLR0 80LNkXQ~zNv;NLN0 90(WNS)Ype 1u-NVXQeOO@bv~zNkXQ(Wz>k@b^\gQ(WNS[E\PYuv;`)Ype0 100-NVXQ gHeT|0W@W kXQ~zNvOO@Wb gHeT|0W@W0vQ-N -NV gOO@bv~zN^kXQvQ~8^E\OO0W@W0-NVXQeOO@bE\lOO(WlQ[0[0m^v ^S_kXQlQ[0[0m^ TyT?bSx0 ~8^E\OO0W /fc~zNy_7bM|@b(W0WgTޏ~E\OONt^N Nv0We0 110~%USMO~zNƋ+Rx0~zN Ty~zNS_vt^@b_-N+T*NSO]FU7bvuN0~%@b_T[ONNUSMOvbS~%0by~%@b_ekXQ,gh0 ~zNƋ+RxkXQzR{vSx0 ~zN TykXQ*NSO]FU7b0*NNrDON0TOON Ty bbSby~%vONNUSMO Ty0 120t^@b_ kXQ(W~zt^^QS_v^@b_yvv6eeQ;`0t^@b_ c 0*NN@b_zL~z3ubRl 0vĉ[{0 Ty@b_v{ NNl^:NUSMO0@b_N^Nl^{v cgqzl[eagO,{VAS Nagvĉ[bTbNl^0 130^~z@b_ kXQ cgq*NN@b_z gsQĉ[{v^S_4~*NN@b_zv@b_0 140]4cb z kXQS_yv@b_(W-NVXQ]~4~bcb4INRN]~cb4vz>k0 150bcbz kXQ*NN@b_zlAQbcbv(W-NVXY]~4~v*NN@b_zz0 160QMQz kXQ*NN@b_zlAQQ_bMQ_v*NN@b_zz0 170,gh:NA4*j_ N_$NT ,{NTbzR:gsQ ,{NT~zNYuX[0 Instructions N0This return is designed in accordance with THE INDIVIDUAL INCOME TAX LAW OF THE PEOPLE S REPUBLIC OF CHINA, THE IMPLEMENTING RULES OF THE INDIVIDUAL INCOME TAX LAW OF THE PEOPLE S REPUBLIC OF CHINA and THE RULES CONCERNING INDIVIDUAL INCOME TAX SELF DECLARATION(provisional), and is applicable for individuals with an annual income of reach 120,000 Yuan. N0Taxable individuals are obliged to fill out and submit the return to the local tax authority within 3 months after the end of the tax year, either by themselves or other entrusted prepares. In case of inability to file the return within the prescribed time limit, an application should be submitted to the local tax authority within prescribed time limit and upon the tax authoritys approval, the filing deadline may be extended. N0The return should be filled out in Chinese or in both Chinese and a foreign language. V0Instructions for filling out various items: 10Year of income incurred and Date or filling: Year of income incurred: The year in which the taxpayer receives the income. Date or filling: the actual date when the return is filed. 20ID Type: The name of the valid identification certificate of the taxpayer(ID Card, passport, solider certificate, military officer certificate, returning permit, etc.) 30ID number: The number of the valid identification certificate of the taxpayer. 40Employer: The taxpayer s employer. The name of the employer for the reporting shall be filled if there are more than one employer. 50Employer s Tax ID Code: The ID code of the taxpayer s employer registered at tax authority either as a taxpayer or as a withholder. 60Industry of Employer: The industry a taxpayer s employer belongs to. It should fall into the general categories of the Categorization of National Economy Industries. 70Title: The taxpayer s official rank at his/her employer. 80Profession: The main profession of the taxpayer. 90Days of stay in China: The actual days stayed in China by a taxpayer without a permanent residence during the tax due period. 100Address in China: The address or the effective contacting address of the taxpayer. For a person without a residence who lives in a hotel, it means the room number and hotel name. 110Taxpayer s Tax ID cole and Taxpayer s Name: Tax ID Code of the business: The number on the tax registration certificate. Name of the business: The name of the taxable self-employed industrial and commercial households, individually-invested enterprises, partnerships, individually-invested or partner-invested private non-enterprises, or enterprises or social service providers partly or wholly funded by state assets under contracted or leased operation. 120Annual Income: The total amount of the corresponding items of income in the tax year. The annual receipts income is calculated in accordance with THE INPLEMENTING RULES OF THE INDIVIDUAL INCOME TAX LAW OR THE PEOPLE S REPUBLIC OF CHINA and THE LAW OF PEOPLES REPUBLIC OF CHINA CONCERNING ADMINISTRATION OF COLLECTION. The calculation shall be in RMB Yuan. Those in foreign currencies shall be converted to the RMB Yuan on the basis of the foreign exchange rate quoted by the competent state foreign exchange authority. 130Taxable income: The part of an income which is subject to the individual income tax. 140Tax pre-paid and withheld: The amount of the tax paid or withheld for the current items of income within China. 150Tax credit: The amount of individual income tax paid outside China that it to be credited against in accordance with the Individual Income Tax Law. 160Tax exempted or deducted: The amount of individual income tax which is to be exempted or deducted in accordance with the Individual Income Tax Law. 170There shall be two original copies of this table in A4 format. One is for the taxpayer and the other is for the tax office for record.     PAGE 2 -  PAGE 1 - PAGE 5 *^htv  D F d f \ ^ p r  , . 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