三、适用的避免双重征税协定 Applicable Double Taxation Agreement:
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______.
四、声明 Declaration
我仅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 tothe best of my knowledge and belief.
申请人签名或盖章：＿＿＿＿＿＿＿
Claimant (Signature or Seal):_______
五、申请人居民身份证明（申请人为其居民的缔约国主管税务机关填写）；或另附对方主管税务机关出具的专用证明。
Certificate of Resident Status of Claimant (For the use of responsible
tax office of the Contracting State in which the claimant is a resident)or attach the special certificate of resident issued by responsible tax
office of the Contracting State in which the claimant is resident.
┌──────────────────────────────────┐
│ Certification │
│ We certify that_______(claimant's name) is a resident of _______ │
│according to the provision of paragraph______, of Article_________ │
│is the Double Taxation Agreement between_____and the People's │
│Repubic of China. │
│ Claimant's serial number: Date: │
│ Signature or Stamp of tax office │
└──────────────────────────────────┘
以下由中国主管税务机关填写(The following for the use of responsible tax
office of China only): 编号（No.）：第 号
