个人税收居民身份声明文件

Individual tax resident status declaration

姓名：                       

Name

本人声明：□ 1.仅为中国税收居民 

I declare        I am a tax resident of China only

□ 2.仅为非居民 

I am a non-resident only  

□ 3.既是中国税收居民又是其他国家（地区）税收居民

I am a tax resident of China and a tax resident of other countries (regions)

如在以上选项中勾选第2项或者第3项，请填写下列信息：

If you check item 2 or 3 above, please fill in the following information

姓（英文或拼音）：              名（英文或拼音）：              出生日期：           

Surname (English or Pinyin)        Given name (English or Pinyin)     Date of birth

现居地址（中文）：        （国家）      （省）      （市）               （境外地址可不填此项）

Current Address(in Chinese)                    (Country)                        (Province)                    (City)                                                         (Overseas address is not required)

（英文或拼音）：        （国家）       （省）       （市）                    

(in English or Pinyin)                             (Country)                          (Province)                        (City)

出生地（中文）：         （国家）      （省）        （市）                   （境外地址可不填此项）

Place of birth(in Chinese)                     (Country)                      (Province)                            (City)                                                                       (Overseas address is not required)

（英文或拼音）：         （国家）       （省）       （市）                   

(in English or Pinyin)                             (Country)                         (Province)                         (City)

税收居民国（地区）及纳税人识别号：

Tax resident country (region) and Taxpayer identification number

1.                                                                 

2.（如有）(If any)                                                  

3.（如有）(If any)                                                  

如不能提供居民国（地区）纳税人识别号，请选择原因：

If the taxpayer identification number of the resident country (region) cannot be provided, please choose the reason:

□ 居民国（地区）不发放纳税人识别号

The resident country (region) does not issue taxpayer identification number

□ 账户持有人未能取得纳税人识别号，如选此项，请解释具体原因：

The account holder fails to obtain the taxpayer identification number. If this option is selected, please explain the specific reasons:

本人确认上述信息的真实、准确和完整，且当这些信息发生变更时，将在30日内通知贵机构，否则本人承担由此造成的不利后果。

I confirm that the above information is true, accurate and complete, and when such information is changed, I will notify your institution within 30 days, otherwise I bear the adverse consequences caused by it.

签名：               日期：

Signature                    Date

签名人身份：            □ 本人             □ 代理人

            Identity of signatory     Myself                        Agent

说明：

Instructions:

1.在中国境内有住所，或者无住所而一个纳税年度内在中国境内居住累计满一百八十三天的个人，为居民个人。在中国境内无住所又不居住，或者无住所而一个纳税年度内在中国境内居住累计不满一百八十三天的个人，为非居民个人。纳税年度，自公历一月一日起至十二月三十一日止。

1.An individual who has a domicile in China or who has no domicile and has resided in China for a total of 183 days in a tax year shall be a resident individual. An individual who has neither domicile nor residence in China, or who has no residence and has resided in China for less than 183 days in a tax year, shall be a non-resident individual. The tax year begins on January 1 and ends on December 31 of the Gregorian calendar.

2.本表所称非居民是指中国税收居民以外的个人。其他国家（地区）税收居民身份认定规则及纳税人识别号相关信息请参见国家税务总局网站（http://www.chinatax.gov.cn/aeoi_index.html）。

2.The term "non-resident" in this table refers to individuals other than Chinese tax residents. Other countries (regions) tax resident identity of rules and taxpayer identification number information please refer to the state administration of taxation website (http://www.chinatax.gov.cn/aeoi_index.html).

3.军人、武装警察无需填写此声明文件。

   3.Military personnel and armed police are not required to fill out this declaration document.

此英文版本仅做参考，具体权利义务条款以中文版本为准。

This English version is for reference only. The specific rights and obligations of the Chinese version shall prevail.