一、 本表适用于取得来源于我国的所得，需享受我国签署的避免双重征税协定（含与港澳避免双重征税安
排）中的非独立个人劳务（受雇所得）、演艺人员和运动员、退休金、政府服务、教师和研究人员、学生条款
的税收协定待遇，或国际运输协定待遇的个人所得税非居民纳税人。
I. This form is applicable to non-resident individuals who claim tax treaty benefits under the articles of
dependent personal services (income from employment), artistes and sportsmen, pensions, government
service, teachers and researchers, students of a Double Taxation Agreement (DTA, including the DTAs with
Hong Kong and Macau Special Administrative Regions) signed by China, or to non-resident taxpayers who
claim treaty benefits under an international transport agreement signed by China.
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 or international transport agreement 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 or international transport agreement
benefits, the latter 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 or international transport agreement benefits in
withholding at source; the rest is for the tax authority to gather information for administrative purposes.
五、非居民纳税人应如实完整填写本表所列问题。如非居民纳税人没有问题所列情况，请在表格中填“无”
。本表所列选择题，请非居民纳税人在符合自身情况的选项对应的□或○中打勾“√”。带有*标识的题目，请具有
题目所描述情况的非居民纳税人填写，与题目所描述情况不符的非居民纳税人无需填写。
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.
六、本表采用中英文双语制作，如中英文表述不一致，以中文为准。如无特别说明，应使用中文填写。
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.
七、本表各栏填写如下：
VII. Instructions on how to fill in each item are as follows:
（一）扣缴义务人基本信息
(I) Basic Information of Withholding Agent
1. 扣缴义务人名称：由扣缴义务人填写税务登记证所载扣缴义务人的全称。
Name of withholding agent: The withholding agent should provide its full name as shown in its tax
registration certificate.
2. 扣缴义务人纳税人识别号：由扣缴义务人填写扣缴义务人税务登记证上注明的“纳税人识别号”。
Tax identification number of withholding agent: The withholding agent should provide its identification
number as shown in the tax registration certificate.
（二）非居民纳税人基本信息
(II) Basic Information of Non-resident Taxpayer
3.非居民纳税人在居民国（地区）姓名：填写非居民纳税人身份证件上的英文全名，如护照上的英文全名。
Name of non-resident taxpayer in resident state (region): Fill in the full English name of the non-resident
taxpayer as shown in his/her ID document, such as the full English name on the passport.
4.非居民纳税人身份证件类型：填写能识别非居民纳税人唯一身份的有效证照名称，如护照。
Type of ID certificate: Fill in the name of the valid certificate that can identify the sole identity of the non-
resident taxpayer, such as a passport.
5.非居民纳税人身份证件号码：填写非居民纳税人身份证件上的号码，如护照号码。
Number of ID certificate: Fill in the number of the ID document of the non-resident taxpayer, such as the
passport number.
6.非居民纳税人享受税收协定或国际运输协定名称：请填写需享受的税收协定或国际运输协定的全称。
Name of the applicable tax treaty or international transport agreement: Please fill in the full name of the
applicable tax treaty or international transport agreement.
7.所得类型：根据非居民纳税人取得实际所得类型选择。本表第三部分，非居民纳税人仅需填写与选择所
得类型相关的题目。
Type of income: Please select the appropriate type of income based on the facts. In Part III of the form,
only relevant queations of selected income type need to be answered by the non-resident taxpayer.
（三）扣缴义务人使用信息
(III) Information for Use by Withholding Agent
8.问题1：从事受雇活动取得的报酬，指非居民纳税人因受雇取得的薪金、工资和其他类似报酬
Question 1: The remuneration derived in respect of an employment refers to salaries, wages and other
similar remuneration derived by the non-resident taxpayer in respect of an employment.
9.问题2，非居民纳税人从事受雇活动的国际运输交通工具的具体类型：如果非居民纳税人是在缔约对方企
业经营的国际运输交通工具上受雇，请说明具体交通工作类型是飞机、船舶、铁路车辆或公路车辆等。
Question 2, “Please specify the type of vehicle of international traffic in which the non-resident taxpayer
carries out employment activities.”: If the non-resident taxpayer exercises employment activities aboard a
ship, aircraft, railway or road vehicle operated in international traffic by an enterprise of the other Contracting
State, please indicate the specific type of vehicle.
10.问题5，该报酬是否由为税收协定缔约对方居民的雇主设在中国的常设机构或固定基地负担：常设机构
是指非居民企业或个人在中国进行全部或部分营业的固定营业场所。固定基地是指从事独立个人劳务活动的人
员从事其业务活动的固定场所（地点）。
Question 5, “Is the remuneration borne by a permanent establishment or a fixed base which the employer
of the other Contracting State has in China?”: “Permanent establishment” refers to a fixed place in China
through which the business of non-resident enterprises or individuals is wholly or partly carried on; “Fixed
base” refers to a fixed place through which an independent personal service of non-resident individuals is
carried on.
11.问题6，非居民纳税人的职业：请说明非居民纳税人是演员、模特、足球运动员、摄影师或制片人等具
体职业。
Question 6, “Occupation of the non-resident taxpayer”: Please indicate the specific type of occupation,
such as actors/actresses, models, football players, cameramen, film producers and so on.
12.问题14，该所得是否因非居民纳税人向缔约对方政府或其地方当局举办的事业提供服务而取得：缔约对
方政府或其地方当局举办的事业，指政府或地方当局从事的与营业有关的事业，如国有公路、邮局、国有剧院
等。
Question 14, “Is the income in respect of services rendered in connection with a public institution
established by the government or a political subdivision or a local authority of the other Contracting State?”:
“A public institution established by the government or a political subdivision or a local authority of the other
Contracting State” refers to a business carried on by the government or a political subdivision or a local
authority of the other Contracting State, such as state-owned highway, post offices, state-owned theaters and
so on.
13.问题15：如非居民纳税人需享受的税收协定中有从特定主体取得的报酬免税的规定，且非居民需享受该
特殊规定，请在本题目中引述相关协定条文，并说明非居民纳税人符合享受该条款待遇的事实情况。
Question 15: If there are special rules on tax exemption for remunerations derived from specific
government institutions in the applicable tax treaty and the non-resident taxpayer indeed need to claim for
treaty treatment under such rules, please quote the contents of such rules and describe the relevant
supporting facts.
14.问题18，非居民纳税人在中国工作情况:（5）如果非居民纳税人在中国从事研究活动，请回答此题，其
他情况无需填写。
Question 18, “Working information of the non-resident taxpayer in China”: Only if it is the case that the
non-resident taxpayer does research in China, please answer the item 5 of this question. There is no need to
answer this item in other cases.
15.问题21，非居民纳税人在学习或实习期间取得所得情况：如果非居民纳税人取得政府或科学、教育、文
化机构或其他免税组织给予的助学金、奖学金或奖金，请回答问题（2），除说明助学金、奖学金或奖金的发放
者名称外，如该助学金、奖学金或奖金有具体名称，也请同时填写该助学金、奖学金或奖金的名称。如果非居
民纳税人在中国为维持生活从事个人劳务活动，请非居民纳税人核对取得所得金额和从事个人劳务活动时间是
否符合税收协定的相关要求。
Question 21, “Information of income gained by the non-resident taxpayer in the period of study or
internship”: If the non-resident taxpayer gains grants, scholarships or awards granted by the government or
scientific, educational, cultural institutions or other tax exempt organizations, please answer the item 2 of the
question. Besides the name of the issuers, please also mention the name of the grants, scholarships or
awards if there is any. If non-resident taxpayer engaged in personal services for the purpose of maintenance,
please judge whether the amount of income gained from and the time spent on the personal services meet
the relevant requirements stipulated in the applicable tax treaty.
16.问题22，请引述纳税人需享受国际运输协定的相关法律条文：请写明法律条文所属法律法规名称和条款
序号，并引述相关法律条文。
Question 22, “Please quote relevant provisions of the applicable international transport agreement”:
Please specify the name of the law, the number of the relevant clauses, and specific provisions.
17.问题23，请简要说明纳税人可享受相关国际运输协定条款的事实情况：在此栏中填写纳税人符合享受相
关国际运输协定的具体事实。例如纳税人是否是缔约对方国家（地区）的国民等。
Question 23, “Please briefly describe the relevant supporting facts”: Please fill in the relevant facts
supporting the claims for treatment under international transport agreement, for example, whether the
taxpayer is a national of the other Contracting State (Region).
（四）税务机关管理使用信息
(IV) Information for Use by Tax Authority
18.问题24，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：如果非居民纳税人近三年在
中国其他地区取得同类所得，受不同税务主管机关管理，应选择“是”，并填写问题25、26。请在问题26中列明
非居民纳税人近三年来源于中国境内其他地区的所有同类所得享受税收协定待遇情况，可另附说明资料。
Question 24, “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 25 and 26 shall be answered. Please
specify all tax treaty or international transport agreement 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 26.
Supporting materials can be attached separately.
（五）附报资料清单
（V）List of Documents Attached
19.非居民纳税人可自行选择提供能够证明非居民纳税人符合享受协定待遇的其他资料。如非居民纳税人提
供其他资料，请在清单上全部列明。
Non-resident taxpayer can provide, on a voluntary basis, other materials to justify the non-resident
taxpayer’s entitlement to the tax treaty or international transport agreement benefits. When providing such
materials, please identify all of them on the list.
（六）备注
(VI) Additional Notes
20.可填写非居民纳税人认为主管税务机关需要了解的其他有助于证明非居民纳税人符合享受协定待遇条件
的信息。如非居民纳税人有特殊情况，也请在备注中注明。
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 or international transport agreement benefits. Please specify the special situations
in the additional notes, if any.
（七）声明
(VII) Declaration
21.由非居民纳税人个人签字或加盖印章，并填写声明日期。
The declaration shall be signed or sealed by non-resident taxpayer personally, and the date of the
statement shall be provided.
八、中国税务机关将对非居民纳税人提交的信息资料保密。
VIII. Any information and materials provided by the non-resident taxpayer will be kept confidential by
China’s tax authorities.
排）中的非独立个人劳务（受雇所得）、演艺人员和运动员、退休金、政府服务、教师和研究人员、学生条款
的税收协定待遇，或国际运输协定待遇的个人所得税非居民纳税人。
I. This form is applicable to non-resident individuals who claim tax treaty benefits under the articles of
dependent personal services (income from employment), artistes and sportsmen, pensions, government
service, teachers and researchers, students of a Double Taxation Agreement (DTA, including the DTAs with
Hong Kong and Macau Special Administrative Regions) signed by China, or to non-resident taxpayers who
claim treaty benefits under an international transport agreement signed by China.
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 or international transport agreement 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 or international transport agreement
benefits, the latter 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 or international transport agreement benefits in
withholding at source; the rest is for the tax authority to gather information for administrative purposes.
五、非居民纳税人应如实完整填写本表所列问题。如非居民纳税人没有问题所列情况，请在表格中填“无”
。本表所列选择题，请非居民纳税人在符合自身情况的选项对应的□或○中打勾“√”。带有*标识的题目，请具有
题目所描述情况的非居民纳税人填写，与题目所描述情况不符的非居民纳税人无需填写。
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.
六、本表采用中英文双语制作，如中英文表述不一致，以中文为准。如无特别说明，应使用中文填写。
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.
七、本表各栏填写如下：
VII. Instructions on how to fill in each item are as follows:
（一）扣缴义务人基本信息
(I) Basic Information of Withholding Agent
1. 扣缴义务人名称：由扣缴义务人填写税务登记证所载扣缴义务人的全称。
Name of withholding agent: The withholding agent should provide its full name as shown in its tax
registration certificate.
2. 扣缴义务人纳税人识别号：由扣缴义务人填写扣缴义务人税务登记证上注明的“纳税人识别号”。
Tax identification number of withholding agent: The withholding agent should provide its identification
number as shown in the tax registration certificate.
（二）非居民纳税人基本信息
(II) Basic Information of Non-resident Taxpayer
3.非居民纳税人在居民国（地区）姓名：填写非居民纳税人身份证件上的英文全名，如护照上的英文全名。
Name of non-resident taxpayer in resident state (region): Fill in the full English name of the non-resident
taxpayer as shown in his/her ID document, such as the full English name on the passport.
4.非居民纳税人身份证件类型：填写能识别非居民纳税人唯一身份的有效证照名称，如护照。
Type of ID certificate: Fill in the name of the valid certificate that can identify the sole identity of the non-
resident taxpayer, such as a passport.
5.非居民纳税人身份证件号码：填写非居民纳税人身份证件上的号码，如护照号码。
Number of ID certificate: Fill in the number of the ID document of the non-resident taxpayer, such as the
passport number.
6.非居民纳税人享受税收协定或国际运输协定名称：请填写需享受的税收协定或国际运输协定的全称。
Name of the applicable tax treaty or international transport agreement: Please fill in the full name of the
applicable tax treaty or international transport agreement.
7.所得类型：根据非居民纳税人取得实际所得类型选择。本表第三部分，非居民纳税人仅需填写与选择所
得类型相关的题目。
Type of income: Please select the appropriate type of income based on the facts. In Part III of the form,
only relevant queations of selected income type need to be answered by the non-resident taxpayer.
（三）扣缴义务人使用信息
(III) Information for Use by Withholding Agent
8.问题1：从事受雇活动取得的报酬，指非居民纳税人因受雇取得的薪金、工资和其他类似报酬
Question 1: The remuneration derived in respect of an employment refers to salaries, wages and other
similar remuneration derived by the non-resident taxpayer in respect of an employment.
9.问题2，非居民纳税人从事受雇活动的国际运输交通工具的具体类型：如果非居民纳税人是在缔约对方企
业经营的国际运输交通工具上受雇，请说明具体交通工作类型是飞机、船舶、铁路车辆或公路车辆等。
Question 2, “Please specify the type of vehicle of international traffic in which the non-resident taxpayer
carries out employment activities.”: If the non-resident taxpayer exercises employment activities aboard a
ship, aircraft, railway or road vehicle operated in international traffic by an enterprise of the other Contracting
State, please indicate the specific type of vehicle.
10.问题5，该报酬是否由为税收协定缔约对方居民的雇主设在中国的常设机构或固定基地负担：常设机构
是指非居民企业或个人在中国进行全部或部分营业的固定营业场所。固定基地是指从事独立个人劳务活动的人
员从事其业务活动的固定场所（地点）。
Question 5, “Is the remuneration borne by a permanent establishment or a fixed base which the employer
of the other Contracting State has in China?”: “Permanent establishment” refers to a fixed place in China
through which the business of non-resident enterprises or individuals is wholly or partly carried on; “Fixed
base” refers to a fixed place through which an independent personal service of non-resident individuals is
carried on.
11.问题6，非居民纳税人的职业：请说明非居民纳税人是演员、模特、足球运动员、摄影师或制片人等具
体职业。
Question 6, “Occupation of the non-resident taxpayer”: Please indicate the specific type of occupation,
such as actors/actresses, models, football players, cameramen, film producers and so on.
12.问题14，该所得是否因非居民纳税人向缔约对方政府或其地方当局举办的事业提供服务而取得：缔约对
方政府或其地方当局举办的事业，指政府或地方当局从事的与营业有关的事业，如国有公路、邮局、国有剧院
等。
Question 14, “Is the income in respect of services rendered in connection with a public institution
established by the government or a political subdivision or a local authority of the other Contracting State?”:
“A public institution established by the government or a political subdivision or a local authority of the other
Contracting State” refers to a business carried on by the government or a political subdivision or a local
authority of the other Contracting State, such as state-owned highway, post offices, state-owned theaters and
so on.
13.问题15：如非居民纳税人需享受的税收协定中有从特定主体取得的报酬免税的规定，且非居民需享受该
特殊规定，请在本题目中引述相关协定条文，并说明非居民纳税人符合享受该条款待遇的事实情况。
Question 15: If there are special rules on tax exemption for remunerations derived from specific
government institutions in the applicable tax treaty and the non-resident taxpayer indeed need to claim for
treaty treatment under such rules, please quote the contents of such rules and describe the relevant
supporting facts.
14.问题18，非居民纳税人在中国工作情况:（5）如果非居民纳税人在中国从事研究活动，请回答此题，其
他情况无需填写。
Question 18, “Working information of the non-resident taxpayer in China”: Only if it is the case that the
non-resident taxpayer does research in China, please answer the item 5 of this question. There is no need to
answer this item in other cases.
15.问题21，非居民纳税人在学习或实习期间取得所得情况：如果非居民纳税人取得政府或科学、教育、文
化机构或其他免税组织给予的助学金、奖学金或奖金，请回答问题（2），除说明助学金、奖学金或奖金的发放
者名称外，如该助学金、奖学金或奖金有具体名称，也请同时填写该助学金、奖学金或奖金的名称。如果非居
民纳税人在中国为维持生活从事个人劳务活动，请非居民纳税人核对取得所得金额和从事个人劳务活动时间是
否符合税收协定的相关要求。
Question 21, “Information of income gained by the non-resident taxpayer in the period of study or
internship”: If the non-resident taxpayer gains grants, scholarships or awards granted by the government or
scientific, educational, cultural institutions or other tax exempt organizations, please answer the item 2 of the
question. Besides the name of the issuers, please also mention the name of the grants, scholarships or
awards if there is any. If non-resident taxpayer engaged in personal services for the purpose of maintenance,
please judge whether the amount of income gained from and the time spent on the personal services meet
the relevant requirements stipulated in the applicable tax treaty.
16.问题22，请引述纳税人需享受国际运输协定的相关法律条文：请写明法律条文所属法律法规名称和条款
序号，并引述相关法律条文。
Question 22, “Please quote relevant provisions of the applicable international transport agreement”:
Please specify the name of the law, the number of the relevant clauses, and specific provisions.
17.问题23，请简要说明纳税人可享受相关国际运输协定条款的事实情况：在此栏中填写纳税人符合享受相
关国际运输协定的具体事实。例如纳税人是否是缔约对方国家（地区）的国民等。
Question 23, “Please briefly describe the relevant supporting facts”: Please fill in the relevant facts
supporting the claims for treatment under international transport agreement, for example, whether the
taxpayer is a national of the other Contracting State (Region).
（四）税务机关管理使用信息
(IV) Information for Use by Tax Authority
18.问题24，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：如果非居民纳税人近三年在
中国其他地区取得同类所得，受不同税务主管机关管理，应选择“是”，并填写问题25、26。请在问题26中列明
非居民纳税人近三年来源于中国境内其他地区的所有同类所得享受税收协定待遇情况，可另附说明资料。
Question 24, “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 25 and 26 shall be answered. Please
specify all tax treaty or international transport agreement 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 26.
Supporting materials can be attached separately.
（五）附报资料清单
（V）List of Documents Attached
19.非居民纳税人可自行选择提供能够证明非居民纳税人符合享受协定待遇的其他资料。如非居民纳税人提
供其他资料，请在清单上全部列明。
Non-resident taxpayer can provide, on a voluntary basis, other materials to justify the non-resident
taxpayer’s entitlement to the tax treaty or international transport agreement benefits. When providing such
materials, please identify all of them on the list.
（六）备注
(VI) Additional Notes
20.可填写非居民纳税人认为主管税务机关需要了解的其他有助于证明非居民纳税人符合享受协定待遇条件
的信息。如非居民纳税人有特殊情况，也请在备注中注明。
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 or international transport agreement benefits. Please specify the special situations
in the additional notes, if any.
（七）声明
(VII) Declaration
21.由非居民纳税人个人签字或加盖印章，并填写声明日期。
The declaration shall be signed or sealed by non-resident taxpayer personally, and the date of the
statement shall be provided.
八、中国税务机关将对非居民纳税人提交的信息资料保密。
VIII. Any information and materials provided by the non-resident taxpayer will be kept confidential by
China’s tax authorities.
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