非居民纳税人享受税收协定待遇情况报告表（企业所得税A表）
Reporting Form for Non-resident Taxpayer Claiming Tax Treaty Benefits
(Form A for Enterprise Income Tax)
（享受税收协定股息、利息、特许权使用费条款待遇适用）
(Applicable to Tax Treaty Benefits under Articles of Dividends, Interest or Royalties)
填表日期： 年 月 日 Filling date: Y M D
货币单位：元人民币 Currency unit: RMB
○ 自行申报 ○ 扣缴申报 ○ 退税 Self-declaration Withholding declaration Tax refund 一、扣缴义务人基本信息 I. Basic Information of Withholding Agent 扣缴义务人纳税人扣缴义务人名称 Name of withholding agent 识别号 Tax identification number of withholding agent 二、非居民纳税人基本信息 II. Basic Information of Non-resident Taxpayer 非居民纳税人中文名称 Chinese name of non-resident taxpayer 非居民纳税人在居民国（地区）的名称 Name of non-resident taxpayer in resident state (region) 非居民纳税人在中国的纳税人识别号 Tax identification number of non-resident taxpayer in China 非居民纳税人在居民国（地区）纳税人识别号 Tax identification number of non-resident taxpayer in resident state (region) 非居民纳税人享受税收协定名称 Name of the applicable tax treaty 所得类型 Type of income ○ 股息 Dividends ○ 利息 Interest ○ 特许权使用费 Royalties 三、扣缴义务人使用信息III. Information for Use by Withholding Agent （一）享受股息条款待遇 (I) Claiming Tax Treaty Benefits under the Article of Dividends 1．非居民纳税人类型 Type of non-resident taxpayer （1）□政府、政府机构 Government or governmental body （2）□税收协定缔约对方政府直接或间接拥有至少20%股份的缔约对方居民公司 Resident company of the other tax treaty contracting party with no less than 20% of its shares held by the government of the other contracting party, whether directly or indirectly （3）□税收协定缔约对方政府直接或间接全部拥有资本的其他实体 Other entity with all its capital held by the governm