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? 收款方名称 Name of *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 *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. recipient 收款方居民国（地区） Resident state (region) of recipient □ 是 请填写下面2个问题 Yes. Please fill in the following two questions □ 否 No 支付比例 Payment percentage 支付时间 Time of payment 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? *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 □ 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. 减免税金额 主管税务机关 In-charge tax authority 时间(年份) Time (year) 所得金额 Amount of income 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 提交时间 （1） Submission date 提交时间 （2） Submission date 提交时间 （3） Submission date 提交时间 （4） Submission date 提交时间 （5） 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 受理日期： 年 日 M D

月 日 D 国家税务总局监制

Date of filing: Y Date of case acceptance: Y M

【表单说明】

一、 本表适用于取得来源于我国的股息、利息、特许权使用费所得，需享受我国对外签署的避免双重征税协定（含与港澳避免双重征税安排）中股息、利息、特许权使用费条款的税收协定待遇的企业所得税非居民纳税人。

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).

二、 本表可用于自行申报或扣缴申报，也可用于非居民纳税人申请退税。非居民纳税人自行申报享受协定待遇或申请退税的，应填写本表一式两份，一份在申报享受协定待遇或申请退税时交主管税务机关，一份由非居民纳税人留存；对非居民纳税人来源于中国的所得实施源泉扣缴或指定扣缴管理的，非居民纳税人如需享受税收协定待遇，应填写本表一式三份，一份交由扣缴义务人在扣缴申报时交主管税务机关，一份由扣缴义务人留存备查，一份由非居民纳税人留存。

II. 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.

三、 本表第一部分由扣缴义务人填写，如非居民纳税人自行申报纳税则无需填写。本表其余部分由非居民纳税人填写。非居民纳税人填报本表时可根据需要增加附页。

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.

四、本表第三部分“扣缴义务人使用信息”用于在源泉扣缴情况下，扣缴义务人核对非居民纳税人是否符合享受协定待遇条件；其他部分用于税务机关采集管理信息。

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.