Certificate of resident status of claimant (To be filled out by the
competent authority of the resident country of the claimant)
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┃根据＿＿＿＿＿同中华人民共和国签订的避免双重征税协定第＿＿条第＿＿款┃
┃规定，谨证明＿＿＿＿＿（申请者名称）为＿＿＿＿＿居民。 ┃
┃We certify that _________ (claimant's mame) is a resident of________┃
┃within the meaning of Paragraph _________, Article_______of the Tax ┃
┃Agreement between __________ and the People's Republic of China. ┃
┃申请人编号： 签署人： 签署日期： ┃
┃Claimant's serial number: Signature: Date: ┃
┃ ┃
┃ 主管税务机关签字或盖章┃
┃ Stamp or signature of competent authority┃
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以下由主管税务机关填写（To be filled out by the competent tax office）
编号（Ref.No.）：＿＿＿
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┃ 收到申请表日期 │ │ 审核日期 │ ┃
┃Date receiving the application│ │Date of veritication │ ┃
┠───────────────┼──┴────────────┴──┨
┃ 审核意见 │ ┃
┃ Comment by the verifier │ ┃
┠───────────────┼──┬────────────┬──┨
┃主办人（签字）Signature by the│ │ 负责人（签字） │ ┃
┃ responsible officer │ │Signature by the officer│ ┃
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主管税务机关盖章（Stamp by the competent tax office）
