发布文号: 国税函（2000）876号
各省、自治区、直辖市和计划单列市国家税务局、地方税务局：
自2000年11月1日起，外籍居民个人储蓄存款利息所得享受税收协定待遇，必须按要求填报《外籍居民个人储蓄存款利息所得享受避免双重征税协定待遇申请表》(以下简称《申请表》，式样附后，各地可根据情况印制)，或提供居民国税务主管当局签发的居民身份证明。原《外国居民享受避免双重征税协定待遇申请表》不再适用于外籍居民个人申请储蓄存款利息所得享受税收协定待遇。
外籍居民个人填报的《申请表》或提供的居民身份证明自首次提交之日起3年内有效，该居民在此期间异地存款要求享受税收协定待遇时，可向原受理税务机关提出，凭其经该机关盖章的《申请表》或居民身份证明复印件申请。如确有必要，有关税务机关可要求纳税人就某项所得单独提供居民身份证明。
附件：外籍居民个人储蓄存款利息所得享受避免双重征税协定待遇申请表
中华人民共和国国家税务总局 State Administration of Taxation，
P.R.China
外籍居民个人储蓄存款利息所得享受避免双重征税协定待遇申请表
Application for Tax Agreement Treatment with Respect to
Depository Interest Received by Foreign Resident Individuals
外籍居民个人储蓄存款利息所得享受避免双重征税协定待遇申请表
Application for Tax Agreement Treatment with Respect to
Depository Interest Received by Foreign Resident Individuals
＿＿＿＿＿税务局 TO＿＿＿＿＿＿＿＿＿＿Tax Office
一、申请人事项(Details of claimant)： 申请日期(Date for application：y/m/d)：＿＿＿＿＿＿
－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－
｜ ｜ ｜ ｜ 国籍 ｜ ｜
｜ 个人 ｜ 全名Full name ｜ ｜ ｜ ｜
｜ ｜ ｜ ｜Nationality ｜ ｜
｜ ｜－－－－－－－－－－－｜－－－－－－－－－－－－－－－｜－－－－－－－－｜
｜ Individual ｜ 住所或居所 ｜ ｜ 邮编 ｜ ｜
｜ ｜Domicile or residence ｜ ｜Post code ｜ ｜
－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－
二、所得事项(Details of income)：
－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－
｜ ｜ 支付人名称 ｜ ｜
｜ ｜ Payer's name ｜ ｜
｜ 利息 ｜－－－－－－－－－｜－－－－－－－－－－－－－－－－－－－－－－－－－－｜
｜ ｜ ｜ ｜ 邮政编码 ｜ ｜
｜ Interest ｜ 地址Address ｜ ｜ ｜ ｜
｜ ｜ ｜ ｜ Postcode ｜ ｜
｜ ｜－－－－－－－－－｜－－－－－－－－－－｜－－－－－－－－｜－－－－－－｜
｜ ｜ 支付金额 ｜ ｜ 支付日期 ｜ ｜
｜ ｜Amount of payment ｜ ｜Date of payment ｜ ｜
－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－
三、个人在中华人民共和国境内的开户银行(Information of the bank in which the applicantopens an account)
银行名称(Name of the bank)：＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿
地址(Address)：＿＿＿＿＿＿＿＿＿＿
四、适用的税收协定(Tax agreement applicable)：
中华人民共和国同＿＿＿＿国签订的避免双重征税协定第＿＿＿条第＿＿＿款。
Paragraph＿＿＿＿Article＿＿＿＿of the Tax Agreement between the People's Republic of
China and＿＿＿＿＿＿＿
五、其它事项(Others)：＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿
我谨在此声明以上呈报事项准确无误。
I hereby declare that the above statement is correct and complete to the best of my knowledge and
belief
申请人签名或盖章：＿＿＿＿＿
Claimant's signature or seal：＿＿＿＿＿
六、申请人居民身份证明(由申请人为其居民的缔约国主管税务机关填写)
Certificate of resident status of claimant (To be filled out by the competent authority of the
resident country of the claimant)
┏━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━┓
┃根据＿＿＿＿＿同中华人民共和国签订的避免双重征税协定第＿＿条第＿＿款┃
┃规定，谨证明＿＿＿＿＿（申请者名称）为＿＿＿＿＿居民。 ┃
┃We certify that _________ (claimant's mame) is a resident of________┃
┃within the meaning of Paragraph _________, Article_______of the Tax ┃
┃Agreement between __________ and the People's Republic of China. ┃
┃申请人编号： 签署人： 签署日期： ┃
┃Claimant's serial number: Signature: Date: ┃
┃ ┃
┃ 主管税务机关签字或盖章┃
┃ Stamp or signature of competent authority┃
┗━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━┛
以下由主管税务机关填写(To be filled out by the competent tax office)
编号(Ref.No.)：＿＿＿＿
－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－
｜ 收到申请表日期 ｜ ｜ 审核日期 ｜ ｜
｜ Date receiving the application ｜ ｜ Date of veritication ｜ ｜
｜－－－－－－－－－－－－－－－－－－｜－－－－－－－－－－－－－－－－－－－－－－－－－－－－－｜
｜ 审核意见 ｜ ｜
｜ Comment by the verifier ｜ ｜
｜－－－－－－－－－－－－－－－－－－｜－－－－－－－－－－－－－－－－－－－－－－－－－－－－－｜
｜ 主办人(签字)Signature by the ｜ ｜ 负责人(签字) ｜ ｜
｜ responsible officer ｜ ｜ Signature by the chief officer｜ ｜
－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－
主管税务机关盖章(Stamp by the competent tax office)
关于填写《外籍居民个人储蓄存款利息所得享受避免双重征税协定待遇申请表》的说明
一、填报范围和程序
(一)本表适用于同中华人民共和国签订避免双重征税协定(以下简称“税收协定”)国家的居民个人，就取得来源于中国的储蓄存款利息所得申请享受税收协定待遇时填报。
(二)本表由存款利息所得人向主管税务机关索取并填写，经当地主管税务机关审核认可后据以执行。
二、本表填写说明
(一)申请人事项
“个人住所或居所”填写申请人在税收上为其居民国家的住所或居所地址及邮政编码。
(二)其它事项
申请人填写对表列各项或其它需要说明的事项。
(三)该表末项所列“主管税务机关盖章”是指主管申请人提出该项税收业务的中国县(市)级税务机关或辖属对外分局，并应加盖本机关公章。
Instructions for Filling out the Application for Tax Agreement Treatmentwith Respect to Depository Interest Received by Foreign Resident Individuals
I. Applicable Scope and procedure for filling out the form
1.1 This Application is applicable to residents of the countries that have concluded the A-greement for the Avoidance of Double Taxation (hereinafter referred to as the 'Tax Agreement')with the People's Republic of China who claim for tax agreement treatment with respect to deposi-tory interest derived in China.
1.2 This form is to be obtained from the competent tax office and completed by the recipientof depository interest. It enters into force consequent to the verification by and upon aproval fromthe competent tax office.
II. Explanations for the items in the Application
2.1 'Details of claimant'： 'Domicile of residence' indicates the address of the claimant'sdomicile of residence and the postcode of the place where the claimant is a resident and qualifiesfor tax purpose.
2.2 'Others'： meaning notes necessary by the claimant on the items listed in the Applicationor other additional but necessary remarks.
2.3 'Stamp by the competent tax office' at the end of the Application means the official stamp bythe tax administration at or above the county or city level or by the affiliated branch thereof that is incharge of the tax affairs in the jurisdiction in which the applicant's tax liability occurs.
