ࡱ>   ɀ\p Ba= ThisWorkbook=x [SO1? [SO14 [SO14 [SO1  [SO1  [SO1 [SO1 [SO1 [SO1  [SO1 [SO""#,##0;""\-#,##0""#,##0;[Red]""\-#,##0""#,##0.00;""\-#,##0.00#""#,##0.00;[Red]""\-#,##0.007*2_ ""* #,##0_ ;_ ""* \-#,##0_ ;_ ""* "-"_ ;_ @_ .))_ * #,##0_ ;_ * \-#,##0_ ;_ * "-"_ ;_ @_ ?,:_ ""* #,##0.00_ ;_ ""* \-#,##0.00_ ;_ ""* "-"??_ ;_ @_ 6+1_ * #,##0.00_ ;_ * \-#,##0.00_ ;_ * "-"??_ ;_ @_ \$#,##0_);\(\$#,##0\)\$#,##0_);[Red]\(\$#,##0\) \$#,##0.00_);\(\$#,##0.00\)% \$#,##0.00_);[Red]\(\$#,##0.00\)                ( ( ( ( ( ( ( ( ( ( ( ( ' ' ' ' ' '    P P         &a> , *    "ff % # !` + ) ' ' ' ' ' '     $    H   H  X X x@ @  x@ @  x@ @  x@ @  x@ @  x@ @   x@ @   x@ @   h X X  @ X  X X X  X X P X x@ @  x@ @   h@ @  x@ @  x x x X  X  X  X  X x@ @  x@ @  x  x@ @  x@ @  x@ @  x@ @  x@ @  x@ @  x@ @  x@ @  x@ @  x@ @  x@ @   x@ @   x@ @   x@ @  x@ @  x@ @  x@ @  x@ @  1|@ @  x@ @  x@ @   x@ @  (x@ @  (x@ @  (x@ @  x@ @  x@ @  x@ @  x@ @  x@ @  x@ @  x@ @   x@ @  x@ @  x@ @  x@ @  x@ @  x@ @  x@ @  x@ @  x x@ @  x@ @  x@ @  x@ @  x@ @  x@ @  x@ @   x@ @   x@ @   x@ @  x@ @  x@ @  x@ @  x@ @  x@ @  x@ @  x@ @  1|@ @  x@ @   x@ @   x@ @   x@ @  x@ @  x@ @   x@ @   x@ @   x@ @   x@ @  !x@ @  !h@ @  !h@ @  x@ @  x@ @  x@ @   h@ @  x@ @   h@ @  x@ @  !20% - :_eW[r 1!20% - :_eW[r 2!20% - :_eW[r 3!20% - :_eW[r 4!20% - :_eW[r 5!20% - :_eW[r 6!40% - :_eW[r 1!40% - :_eW[r 2!40% - :_eW[r 3!40% - :_eW[r 4!40% - :_eW[r 5!40% - :_eW[r 6!60% - :_eW[r 1!60% - :_eW[r 2!60% - :_eW[r 3!60% - :_eW[r 4! 60% - :_eW[r 5!!60% - :_eW[r 6 "Normal 3# $h %h 1 &h 2 'h 3 (h 4)] *8^ĉ 4S+'8^ĉ_ 0^E\lON@b_zt^^~z3ubh 0(uNnc[3ubON (u~ĉ-N ?Q @eQ Alʑ`| *NN@b_zDh`kXbfrmSheet3VV8 } N0,gh(uNS_egnNbVv@b_ NSbV~{rvMQS͑_zOS[+TN/noMQS͑_z[c -Nv^rz*NNRRSǖ@b_ 0ozNXTTЏRXT0Oё0?e^ gR0Ye^TxvzNXT0f[uag>kvz6eOS[_G bVEЏOS[_Gv*NN@b_z^E\l~zN0Qi 7 I. This form is applicable to non-resident individuals who claim tax treaty benefits under the articles of dependent personal services (income from employment), artistes and sportsmen, pensions, government service, teachers and researchers, students of a Double Taxation Agreement (DTA, including the DTAs with Hong Kong and Macau Special Administrative Regions) signed by China, or to non-resident taxpayers who claim treaty benefits under an international transport agreement signed by China. 7 N0,ghS(uNL3ubbcb43ub _NS(uN^E\l~zN3uz0^E\l~zNL3ubNSOS[_Gb3uzv ^kXQ,ghN_$NN NN(W3ubNSOS[_Gb3uzeN;N{zR:gsQ NN1u^E\l~zNYuX[[^E\l~zNegnN-NVv@b_[enlcb4v ^E\l~zNYNSz6eOS[_G ^kXQ,ghN_ NN NNN1ucb4INRN(Wcb43ubeN;N{zR:gsQ NN1ucb4INRNYuX[Yg NN1u^E\l~zNYuX[0  7II. 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.  7J N0,gh,{NR1ucb4INRNkXQ Y^E\l~zNL3ub~zRekXQ0,ghvQYOR1u^E\l~zNkXQ0^E\l~zNkXb,gheS9hncXRDu0-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. 7J V0,gh,{ NR cb4INRNO(uOo` (uN(Wnlcb4`Q N cb4INRN8h[^E\l~zN/f&T&{TNSOS[_GagNvQNR(uNzR:gsQǑƖ{tOo`0     7BIV.  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. 7 N0^E\l~zN^Y[[tekXQ,gh@bR0Y^E\l~zNl g@bR`Q (WhVII. Instructions on how to fill in each item are as follows:  7 N cb4INRNW,gOo`. (I) Basic Information of Withholding Agent# 1.cb4INRN Ty1ucb4INRNkXQzR{v@b}cb4INRNvhQy0}Name of withholding agent: The withholding agent should provide its full name as shown in its tax registration certificate. . 2.cb4INRN~zNƋ+RS1ucb4INRNkXQcb4INRNzR{v Nlfv ~zNƋ+RS 0%&,- 7Tax identification number of withholding agent: The withholding agent should provide its identification number as shown in the tax registration certificate. N ^E\l~zNW,gOo`2 (II) Basic Information of Non-resident Taxpayer 70 3.^E\l~zN(WE\lV0W:S Y TkXQ^E\l~zNNN NvehQ T Ybgq NvehQ T0  7 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.  7* 4.^E\l~zNNN{|WkXQƋ+R^E\l~zN/UNNv gHegq Ty Ybgq0 7Type 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. 7& 5.^E\l~zNNNSxkXQ^E\l~zNNN NvSx YbgqSx0 7zNumber of ID certificate: Fill in the number of the ID document of the< non-resident taxpayer, such as the passport number. 7. 6.^E\l~zNNSz6eOS[bVEЏOS[ TykXQNSvz6eOS[bVEЏOS[vhQy0 7Name of the applicable tax treaty or international transport agreement: Please fill in the full name of the applicable tax treaty or international transport agreement.8 7.@b_{|W9hnc^E\l~zNS_[E@b_{|W b0,gh,{ NR ^E\l~zNNkXQN b@b_{|WvsQvv0 7Type 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. 7  N cb4INRNO(uOo` 71  (III) Information for Use by Withholding Agent 7+ 8.1NNSǖ;mRS_vbl c^E\l~zNVSǖS_vё0]DTvQN{|NRvNNcO gR S_~[e?e^bvQ0WeS_@\>NRvNN c?e^b0WeS_@\NNvN%N gsQvNN YV glQ0@\0V ggRbI{0   7%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. 7] 13.15Y^E\l~zNNSvz6eOS[-N gNyr[;NSOS_vblMQzvĉ[ N^E\lNSyrkĉ[ (W,gv-N_vsQOS[age v^f^E\l~zN&{TNSag>k_GvN[`Q0( 7CQuestion 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. 7: 14.18 ^E\l~zN(W-NV]\O`Q:5 Yg^E\l~zN(W-NVNNxvz;mR VT{dk vQN`QekXQ0     7Question 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. 7 15.21 ^E\l~zN(Wf[`Nb[`NgS_@b_`QYg^E\l~zNS_?e^byf[0Ye0eS:ggbvQNMQz~~~NvRf[ё0VYf[ёbVYё VT{2 dfRf[ё0VYf[ёbVYёvS>e TyY Y勩Rf[ё0VYf[ёbVYё gwQSO Ty _N TekXQ勩Rf[ё0VYf[ёbVYёv Ty0Yg^E\l~zN(W-NV:N~cu;mNN*NNRR;mR ^E\l~zN8h[S_@b_ёTNN*NNRR;mRe/f&T&{Tz6eOS[vvsQBl0  OP  7Question 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 p< ersonal services meet the relevant requirements stipulated in the applicable tax treaty. 7> 16.22 _~zNNSVEЏOS[vvsQl_ageQfl_age@b^\l_lĉ TyTag>k^S v^_vsQl_age0 7Question 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. 7U 17.23 {f~zNSNSvsQVEЏOS[ag>kvN[`Q(Wdkh-NkXQ~zN&{TNSvsQVEЏOS[vwQSON[0OY~zN/f&T/f~[eV[0W:S vVlI{0 7 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). V zR:gsQ{tO(uOo`, (IV) Information for Use by Tax Authority 18.24 ^E\l~zNя Nt^/f&T gegnN-NVXQvQN0W:Sv T{|@b_Yg^E\l~zNя Nt^(W-NVvQN0W:SS_ T{|@b_ S N TzR;N{:gsQ{t ^ b /f v^kXQ250260(W26-NRf^E\l~zNя Nt^egnN-NVXQvQN0W:Sv@b g T{|@b_NSz6eOS[_G`Q SSDfDe0MNOPVXY[`b 7Question 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. 7 N DbDenUS  V List of Documents Attached@ 19.^E\l~zNSL bcOYf^E\l~zN&{TNSOS[_GvvQNDe0Y^E\l~zNcOvQNDe (WnUS NhQRf0Non-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.  7 mQ Yl(VI) Additional NotesJ 20.SkXQ^E\l~zN:N;N{zR:gsQN㉄vvQN gRNf^E\l~zN&{TNSOS[_GagNvOo`0Y^E\l~zN gyrk`Q _N(WYl-Nlf0`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. 7 N Xf(VII) Declaration 21.1u^E\l~zN*NN~{W[bRvpSz v^kXQXfeg0  7The declaration shall be signed or sealed by non-resident taxpayer personally, and the date of the statement shall be provided. 7 kQ0-NVzR:gsQ\[^E\l~zNcNvOo`DeO[0 7VIII. Any information and materials provided by the non-resident taxpayer will be kept confidential by China s tax authorities. 7 DN 10 Appendix 10 7^E\l~zNNSz6eOS[_G`QbJTh*NN@b_zDh  7iReporting Form for Non-resident Taxpayer Claiming Tax Treaty Benefits (Form D for Individual Income Tax) 7$ NS^rz*NNRR0ozNXTTЏRXT0Oё0?e^ gR0 Ye^TxvzNXT0f[uag>k bVEЏOS[_G(u (Applicable to Tax Treaty Benefits under the Article of Dependent Personal Services, Artistes and Sportsmen, Pensions, Government Service, Teachers and Researchers or Students, or Treaty Benefits under International Transport Agreement) 8  75 kXheg t^ g e Filling date: Y M D     7 '^USMOCQNl^ Currency unit: RMB   %L3ub   7  0cb43ub  7 0z  7! Self-declaration  7$ Withholding declaration 7 Tax refund4 N0cb4INRNW,gOo` `!.Basic Information of Withholding Agent ! cb4INRN Ty Name of withholding agent : cb4INRN~zNƋ+RS Tax identification number of withholding agent  79 N0^E\l~zNW,gOo` a!.Basic Information of Non-resident Taxpayer   71 ^E\l~zN-Ne Ty Chinese name of non-resident taxpayer  7I ^E\l~zN(WE\lV0W:S Y T Name of non-resident taxpayer in resident state (region) 7# ^E\l~zNNN{|W Type of ID certificate  7% ^E\l~zNNNSx Number of ID certificate  7\ ^E\l~zNNSz6eOS[bVEЏOS[ Ty Name of the appl< icable tax treaty or international transport agreement @b_{|W Type of Income8  % ^rz*NNRR Dependent personal services   7%  % ozNXTTЏRXT Artistes and sportsmen  7%  % Oё Pensions 7,  % ?e^ gR Government service 7&  % Ye^TxvzNXT Teachers and researchers 7(  % f[u Students 71  % VEЏ International transport 76  N0cb4INRNO(uOo` b!.Information for Use by Withholding Agent  7 (N)NS^rz*NNRRSǖ@b_ ag>k_G (`!) Claiming Tax Treaty Benefits under the Article of Dependent Personal Services (Income from Employment) 7 1@b_/f&T:NNNSǖ;mRS_vbl N^\N^(uz6eOS[cN90ozNXTTЏRXT0Oё0?e^ gR0Ye^TxvzNXT0f[uag>kv@b_ Is the remuneration derived in respect of an employment, but not covered by the articles of directors' fees, artistes and sportsmen, pensions, teachers and researchers, and students? F 7  %/f Yes %&T No   2@b_/f&T:N(W~[eON~%VEЏv960ޘ:g0bFЏf NNNSǖ;mRS_vbl Is the remuneration derived in respect of an employment exercised aboard a ship, aircraft or land vehicle operated in international traffic by an enterprise of the other Contracting State?  / 7Y  %/f kXQN]wQwQSO{|W Yes. Please indicate the specific type of the traffic vehicle %&T No  T V 7  *^E\l~zNNNSǖ;mRvVEЏN]wQvwQSO{|W Please specify the type of vehicle of international traffic in which the non-resident taxpayer carries out employment activities  7Q 3^E\l~zN(W-NVXQ\PYue`Q Duration of the non-resident taxpayer's presence in China  7V 1 NNlQSt^^(W-NVXQ[E\PYue Actual presence period in China in the last calendar year   7 0R-NVeg Arrival date in China  y_-NVeg Departure date from China  \PYu)Ype Days present in China  7j 2 ,gt^^(W-NVXQ[E\PYueb\PYue Actual or estimated presence period in China in the current calendar year   7Y 3 NNlQSt^^(W-NVXQ\PYue Estimated presence period in China in the next calendar year   7 4勥bl/f&T1u:Nz6eOS[~[eE\lvǖ;N/eNbNhǖ;N/eN Is the remuneration paid by, or on behalf of, an employer who is a resident of the other Contracting State? " 7 5勥bl/f&T1u:Nz6eOS[~[eE\lvǖ;N(W-NVv8^:ggbV[W0Wb Is the remuneration borne by a permanent establishment or a fixed base which the employer of the other Contracting State has in China? ( 7^ (N)NSozNXTTЏRXTag>k_G (a!)Claiming Tax Treaty Benefits under the Article of Artistes and Sportsmen  78 6^E\l~zNvLN Occupation of the non-resident taxpayer   7 7^E\l~zNNNv;mR^\NN NTy`Q Type of activities exercised by the non-resident taxpayer 1 %?e^eSNAmR Cultural exchange program agreed upon by the governments of both Contracting States feSNAmR Ty Please indicate the name of the cultural exchange program 2 %?e^SONAmR Sports exchange program agreed upon by the governments of both Contracting States fSONAmR Ty Please indicate the name of the sports exchange program 3 %vQN Others  V WX c   &    7.  *NAmR Ty Name of the exchange program  7B 8^E\l~zN(W-NV_U\;mRv?e^DR`Q Information of government supporting on the activities exercised by the non-resident taxpayer in China 1 % 1u~[e?e^bvQ0WeS_@\Dёb[NvlQqQWёDR fDR Ty Substantially supported by the Contracting State or other local authorities thereof, or public funds establised by them. Please indicate the name of the sponsor 2 % 1u-NV?e^DёblQqQDёDR fDR Ty Substantially supported by Government of China, or its public funds Please indicate the name of the sponsor 3 %vQN Other cases  ]    z {| ~  / 01 5 7"  *DR Ty Name of the sponsor  7q ( N)NSOёag>k_G (b!)Claiming Tax Treaty Benefits under the Article of Pensions   7$ 9< Oё/eNN Ty Name of pension payer  7 10Oё/f&T9hnc~[e>yOO6R^blQqQOi6R^/eN Are the pensions made by the other Contracting State under its social security system or public welfare plan?  7d 11^E\l~zN(W-NVE\OObRE\OOe Actual or estimated residence period in China of the non-resident taxpayer  7 _Y(W-NVE\OOe Starting date . ~_gbR~_g(W-NVE\OOe Ending or estimated ending dated (V)NS?e^ gRag>k_G (c!)Claiming Tax Treaty Benefits under the Article of Government Services  7 12^E\l~zN/f&TT~[e?e^bvQL?e:Sb0WeS_@\cO gR S_勥bl Is the remuneration in respect of services rendered to the government or political subdivision or a local authority of the other Contracting State? ( 7]  % /f f@b gR:gg Ty Yes. Please indicate the name of the government institution % &T No   W XY Z 7>  *^E\l~zN@b gRv?e^:gg Ty Name of the government institution  7i 13^E\l~zNS_@b_/f&T:NOё Shall the income received by the non-resident taxpayer be regarded as a pension?  7O  %/f VT{ NN Yes. Please answer the next question. %&T No  J L 7  *Oё/f&T/f1u~VNe?e^0L?e:S00WeS_@\/eNvbNvQ^zvWё-N/eNv Is the pension paid by, or out of funds created by, the government or a political subdivision or a local authority of the other Contracting State? / 7 14@b_/f&TV^E\l~zNT~[e?e^bvQ0WeS_@\>NRvNNcO gR S_ Is the income derived 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? * 73 *15Y^E\l~zNNSvz6eOS[ gyrkĉ[N^E\l~zNNSyrk'`ag>k _l_agev^f^E\l~zN&{TNSag>k_GvN[`Q0 If there are special rules 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. J 7 c:yYg~zN9hnc-NVvz6el_ĉ[]b:N-NVvE\l~zN N N/fN1uNcOy?e^ gR b:N-NVz6eE\lv HN~zNvdkyё0]DTvQ[{|k_G (d!)Claiming Tax Treaty Benefits under the Article of Teachers and Researchers  7 16^E\l~zN/f&TV[eeSNAmyvbR(W-NV\PYu Does the non-resident taxpayer stay in China under an official programme or plan of cultural exchange?   7R  %/f fyvbR Ty Yes. Please indicate the name of the programme or plan. %&T NoMO 7T  *[eeSNAmyvbR Ty Name of the official programme or plan of cultural exchange  7 17^E\l~zN(W-NVcOYef[0xvz gR:gg`Q Information of the institution where the non-resident taxpayer renders services of teaching or research   7 1 ^E\l~zN(W-NVcOYef[0xvz gRv:gg^\N NTy`Q Please indicate the type of the institution where the non-resident taxpayer renders services of teaching or research.  ! 7 %Ye:gg Eductional institutions  7 %yx:gg Research institutions  7 %ZSir Museums , %vQNeS:gg Other type of cultural institutions 7 2 ^E\l~zNcOYef[0xvz gR:gg Ty Name of the institution   7 3 ^E\l~zNcOYef[0xvz gR:gg/f&T&{TvQSXNXTSNSYe^TxvzNXTag>kz6eOS[_Gvĉ[Bl Does the institution meet the requirements of claiming for tax treaty treatment for its teachers and researchers?  6 7  %/f Yes %&T No  O 18^E\l~zN(W-NV]\O`Q Working information of the non-resident taxpayer in China   7 1 ^E\l~zN/f&TN-NVXQYebxvz:gg gX(usQ| Is there any employment relationship between the non-resident taxpayer and the educational or research institution in China? 7: 2 ^E\l~zNX(uT T_Yeg Starting date of the employment contract  5 ^E\l~zNX(uT T~bkeg Ending date of the employment cont< ract  3 ^E\l~zNVcOdkyYef[0xvz gR,{N!k0R-NVveg The first arrival date of the non-resident taxpayer for the sake of rendering services of teaching or research in China   7 4 ^E\l~zN(WX(uUSMO;NNNv;mRv{|W Type of activity carried out by the non-resident taxpayer in the institution %Yef[ Teaching %^ Giving Lectures %xvz Research %ĉR0TbL?e{t;mR Planning, consulting or administrative activities %vQN Others  w z     7 *5 Yg^E\l~zNNNxvz;mR xvz;mR/f&T/f gRNlQqQ)Rv N/f;N:NNg*NNbgNNvyN)Rv _U\ If the non-resident taxpayer carries out research activities, is the research undertaken in the public interest instead of primarily for the private benefit of a specific person or persons?  ; 7G mQ NSf[uag>k e! Claiming Tax Treaty Benefits under the Article of Students  7 19^E\l~zN/f&TN1uNcSYe0WbSyr+Rvb/g~vvv\PYu(W-NV Is the non-resident taxpayer present in China for the purpose of receiving education, training or access to special technical experience?  * 7] 20^E\l~zN(W-NVf[`Nb[`N`Q Study or internship information of the non-resident taxpayer in China  7{ 1 ^E\l~zN(W-NVf[`Nb[`Nvf[!h0:gg Ty Name of the school or instituation where the non-resident taxpayer studies or does internship   7) 2 ^E\l~zN(W-NVf[`Nb[`Nv_Ye Starting date   7A ^E\l~zN(W-NVf[`Nb[`Nv~_gb~_ge Ending date or estimated ending date 7 3 ^E\l~zNVdkyf[`Nb[`N,{N!k0R-NVveg The first arrival date of the non-resident taxpayer for the sake of study or internship in China   7z 21^E\l~zN(Wf[`Nb[`NgS_@b_`Q Information of income gained by the non-resident taxpayer in the period of study or internship  7 1 ^E\l~zNS_@b_^\NN NTy`QY Please indicate type(s) of the income gained by the non-resident taxpayer (maybe more than one answer)   7 % :N~cu;m0cSYe0f[`N0xvzbWvvv N-NVXYS_v>ky The income gained outside China for the purpose of maintenance, study, research, education or training  # 7 % ?e^byf[0Ye0eS:ggbvQNMQz~~~NvRf[ё0VYf[ёbVYё Grants, scholarships or awards granted by the government or scientific, educational, cultural institutions or other tax exempt organizations  # 7p % (W-NV:N~cu;mNN*NNRRS_v@b_ The income gained from the personal services for the purpose of maintenance in China   7 % vQN Others   7Z *2 Yg^E\l~zNS_?e^byf[0Ye0eS:ggbvQNMQz~~~NvRf[ё0VYf[ёbVYё f NRf[ё0VYf[ёbVYёvS>e Ty 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 indicate the name of the issuers of the first-mentioned grants, scholarships or awards.  F 7 *3 Yg^E\l~zN(W-NV:N~cu;mNN*NNRR;mR S_@b_ёTNN*NNRR;mRe/f&T&{TNSz6eOS[vvsQBl If non-resident taxpayer engaged in personal services for the purpose of maintenance, do the amount of income and the time of personal services meet the relevant requirements stipulated in the applicable tax treaty ?  @ 7T N NSVEЏOS[_G f! Claiming Treaty Benefits under an International Transport Agreement   7s 22_~zNNSVEЏOS[vvsQl_age Please quote relevant provisions of the applicable international transport agreement 7Y 23{f~zNSNSvsQVEЏOS[ag>kvN[`Q Please briefly describe the relevant supporting facts  76 V0zR:gsQ{tO(uOo` c!. Information for Use by Tax Authorities 7 24^E\l~zNя Nt^/f&T gegnN-NVXQvQN0W:Sv T{|@b_ Has the non-resident taxpayer received any income of the same type sourced in other regions within China over the past three years?! 7 *25^E\l~zNя Nt^/f&T1\egnN-NVXQvQN0W:Sv T{|@b_NSǏz6eOS[_G 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?+ 7 *26f^E\l~zNя Nt^1\egnN-NVXQvQN0W:Sv T{|@b_NSz6eOS[_Gv`Q Please indicate the details of any tax treaty benefits claimed by the non-resident taxpayer for the same type of income sourced in othe<r regions within China over the past three years.- 7 ;N{zR:gsQ In-charge tax authority et^N Time (year) 7 @b_ё Amount of income  1  7 2  7 3  7 4  7 5  7% N0DbDenUS d!.List of Documents Attached 27^E\l~zNL bcOvYfvQ&{TNSOS[_GvvQNDenUS List of other documents provided by the non-resident taxpayer on a voluntary basis to justify entitlement to treaty benefits% 7 1  2  3  4  5  28^E\l~zNNMR]cN dk!kSNMQN͑ YcNvDenUSTcNe List of documents submitted before (and need not to be resubmitted) / Date of submission$ 7 cNe Submission date 7 mQ0Yl VI. Additional Notes N0Xf f!.Declaration    b(XfN NHTbNyw[0Qnx0e0 I hereby declare that the information given above is true, accurate and error-free. ^E\l~zN~{zb~{W[ t^ g e Seal or signature of the non-resident taxpayer Y M D  y     7( cb4INRNlQz Seal of the withholding agent:   7" Nt3ub-NN:gglQz Seal of the tax agent: ; ;N{zR:gsQStN(uz Dedicated seal of the in-charge tax authority:  7# ~RN Signature of the case handler: 7 StN Received by:V kXheg t^ g e Date of filing: Y M D$& 7X 3ubeg t^ g e Date of filing: Y M D0$&W 7V Steg t^ g e Date of case acceptance: Y M D!"(* 7 V[zR;`@\v6R 7  0^E\l~zNNSz6eOS[_G`QbJTh*NN@b_zDh 0  4 NS^rz*NNRR0ozNXTTЏRXT0Oё0?e^ gR0Ye^TxvzNXT0f[uag>k bVEЏOS[(u  ( 7 kXhfInstructions for Filling out the Reporting Form for Non-resident Taxpayer Claiming Tax Treaty Benefits (Form D for Individual Income Tax) 7(Applicable to Tax Treaty Benefits under the Article of Dependent Personal Services, Artistes and Sportsmen, Pensions, Government Service, Teachers and Researchers or Students, or Treaty Benefits under International Transport Agreement) 7 19<OAK+ .Xdn$ty1|qiz&ڡ ]'mSq cc||| }-}$ .00\)_ *}A}% .00\)_ *;_ @_ }A}& .00\)_ *?;_ @_ }A}' .00\)_ *23;_ @_ }-}( .00\)_ *}A}- a.00\)_ *;_ @_ }A}) .00\)_ *;_ @_ }A}> e.00\)_ *;_ @_ }}@ ??v.00\)_ *̙;_ @_    }}? ???.00\)_ *;_ @_ ??? ??? ??? ???}}1 }.00\)_ *;_ @_    }A}5 }.00\)_ *;_ @_ }}2 .00\)_ *;_ @_ ??? ??? ??? ???}-}4 .00\)_ *}x}A.00\)_ *;_ ??? ??? ???}-}3 .00\)_ *}U}. .00\)_ *;_  }A}8 .00\)_ *;_ }A} .00\)_ *ef;_ }A} .00\)_ *L;_ }A} .00\)_ *23;_ }A}9 .00\)_ *;_ }A} .00\)_ *ef;_ }A} .00\)_ *L;_ }A} .00\)_ *23;_ }A}: .00\)_ *;_ }A} .00\)_ *ef;_ }A} .00\)_ *L;_ }A} .00\)_ *23;_ }A}; .00\)_ *;_ }A} .00\)_ *ef;_ }A} .00\)_ *L;_ }A} .00\)_ *23;_ }A}< .00\)_ *;_ }A} .00\)_ *ef;_ }A} .00\)_ *L;_ }A}  .00\)_ *23;_ }A}= .00\)_ * ;_ }A} .00\)_ *ef ;_ }A} .00\)_ *L ;_ }A}! .00\)_ *23 ;_ O20% - :_eW[r 1 ef %O"20% - :_eW[r 2 ef %O&20% - :_eW[r 3 ef %O*20% - :_eW[r 4 ef %O.20% - :_eW[r 5 ef %O220% - :_eW[r 6  ef %O40% - :_eW[r 1 L %O#40% - :_eW[r 2 L渷 %O'40% - :_eW[r 3 L %O+40% - :_eW[r 4 L %O/40% - :_eW[r 5 L %O340% - :_eW[r 6  Lմ %O 60% - :_eW[r 1 23 %O$60% - :_eW[r 2 23ږ %O(60% - :_eW[r 3 23כ %O,60% - :_eW[r 4 23 %O060% - :_eW[r 5 23 %O460% - :_eW[r 6  23 %~vRk+h I}%=h 1 I}%O=h 2 I}%?=h 3 I}%23/h 4 I}%5]  %8^ĉ5}Y  a%GGl;` %OO'^ '^[0]o{  }% uhgUSCQ0R 44600dpidMicrosoft Office Excel ؞SbpSn   -EXCEL.EXEC:\Program Files\Microsoft Office\OFFICE11\EXCEL.EXE< " dXX??U} 3B} L B}  B} 3B} C} CI@@@X@Y@J@@@@ v@ '@ e@ @ @@@@@@ @@@@@@@@@X@X@X@@ bHb cIccccc dJddddd eKfffffE aLa aMa iNi _O_ `P` _Q_ [R[ `S` \T]]]]] FU ^^ FV ^^ jW jjjjj FX gg HY hh FZ gg H[ kk J\ lmmmn o] r^ ssstp r_ssstp r`ssstp rassstp rbssstp rcssstq rdssst uevvvvw xfyyyyz ^g ^^^ ^h^ {i {{{ ^j^ {k{{{gg ^l^^^^^ {m{{{{{ gng gog gpg||gggg||gggg||gggg {q{{{{{Dl""$0HH"8"88".******""66"""H @!X@"X@#X@$@%@&X@'X@(X@)@*e@+@,@-@.@/ @0u@1@2@3@4@5E@6@7S@8@9@@:@;@<m @=@>@?F@ gn g go g gp g!||gggg"||gggg#||gggg ${r${{{{{ %gn%g %go%g %gp%g&||gggg'||gggg(||gggg )^s )^^^ )^h)^ *^t *^^^ *^h*^ +\u+\\\\\ ,{v,{gggg -^w-^^^^^ .}x.~hhhh /{y/{{{{{ 0}z0~gggg 1\{1\\\\\ 2^|2^gggg 3^} 3^^^ 3^h3^ 4{~4{{{{{ 5G 5gg 5G 5gg 6\6\\\\\ 7^ 7^^^ 7^7^ 8}8~gggg 9{ 9{{{ 9^9^ :{ :{{{ :^h:^ ;{ ;{{{ ;^h;^ << == >\>\\\\\ ?} ?~ ??DzlH"H66""""""""6"8"6"666"""@@AV@BV@C@D@E`@F@G@Hs@I&@J @K@L@M@N@Of@P@Q@RU@S@T@U@V@W@X@Y @Z@[@\" @]" @^@_G@ @{@{gggg A}A~ BB C C C C D D D D EE F} F~ FF G}G~ Hr Hsst HH IK Igg IK Ikk J{J{{ggg K{K{{{{{ L} L~ LL M\M\\\\\ N} N~ NN O}O~ P}P~ QL Qgg QL Qgg R{R{gggg S}S~ TT UU VV WW XX YY Z{ Z{{{ ZZ [u[vvvvw \\ ]] ^^ _r _sss __Dl"""88"6"68""6"6""8""""""""6""""`E@ae@b@c@d@e@f@g@h+@i@j@k@l@m@n@o@p:@qX@rX@sv@t@uv@v@w(@xP@yP@zJ@|}~ ` ` `` aa bkbk blbn bb ccln ddln eeln ffln gglnln hh iijjjjj jIj kIk lIl mIm nIn oo pI p pJpM qI q qJqM rI r rJrM s\s\\\\\t^^^^^^ ujujjjjj vv ww ww ww xx xx xx yy yy yyzNNNN z`z`|OOOOOO}OOOOOO~OOOOOOOOOOOOB>X6"H"""""""""""""666"""HHH*OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOD@lOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOD@lOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOz>@wwwwwwzzxxxxxxyyyyyyqqrrssttgghhuuvvkkllmmnnooppiijjeeeeeeffffffggggccccccddddddaabbbbbb\\]]^^````TT____WWXXYYYYZZZZ[[QQRRRRSSLLLLUUVVNNNNOOPPPPQQIIJJJJKKCCDDDDMMFFFFGGHHHHIIEEEE>>????@@@@AABBCC==777788889999::::;;445555<<;;--66//00001122223333****++,,,,''''''....(((((())))$$&&&&&&""""######%%%%%%!!!!!!""           7 Sheet1ggD&J  ɀ Ma#fjl  dMbP?_*+%8"8J??U} ZZ} QM@@@@@@@@ @ @ <@ @ @ @d@@X@@@@@YYYY@@YYYYY P R R D R S T U U U U U U U U V V U U W W X X X X W W X X X X XD@l Y!Y"Y#Y$Y%@&@'Y(Y)Y*Y+Y,Y-XY.Y/Y0Y1vY2Y3vY4fY5OY6Y7vY8Y9vY:Y;@<@=@>r@?@ X !X "X #X $X %W &W! 'X" (X# )X$ *X% +X& ,X' -X( .X) /X* 0X+ 1X, 2X- 3X. 4X/ 5X0 6X1 7X2 8X3 9X4 :X5 ;W6 <W7 =X8 >X9 ?W:D@l@@AYBYC@D@EYFYG@H@IYJYK@L@ @W; AX< BX= CW> DW? EX@ FXA GWB HWC IXD JXE KOF LUG>@7 Sheet2ggD&  ɀ *n  dMbP?_*+%8"8??U>@7 Sheet3ggD& Oh+'0HP\h Microsoft Excel@EW.@2@ W.՜.+,0HP X`hp x ' ˰D ˵Sheet3   !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry FWorkbooknSummaryInformation(DocumentSummaryInformation8