二、申请人声明 Declaration of claimants:
　　我仅在此声明以上呈报事项准确无误。
　　I hereby declare that above statement is correct and complete to the best of my knowledge and belief.
　　　　申请人签名或盖章 Claimant (Signature or Seal):________
　　三、申请人居民身份证明（由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或航运主管部门出具的专用证明。
　　Certificate of resident status of the claimant (For the use of the Tax authority of the Contracting State in which the claimant is a resident) or attach the special certificate of resident issued by the tax or shipping authorities of the Contracting State in which the claimant is a resident.

┌──────────────────────────────────────┐
│　　　　　　　　　　　　　　　 Certificartion　　　　　　　　　　　　　　　 │
│　　We certify that____(claimant's name) is a resident of ____ according to │
│the Provisions of praragraph____of Article____in the Double Taxation　　　　│
│Agreement between____and the People's Republic of China.　　　　　　　　　　│
│　　Claimant's serial number:　　　　　　 Date:　　　　　　　　　　　　　　 │
│　　　　　 Signature or stamp of tax office　　　　　　　　　　　　　　　　 │
└──────────────────────────────────────┘

　　四、申请免税的依据（请在适当方格内打√号）Applicable treaties(√ the appropriate box(es)):
　　根据中华人民共和国政府和________　国政府签订的：________
　　In accordance with the provisions in Article (Articles) ________ of the following treaty (treaties) between the Government of the People's Republic of China and the Government of ________,
　　□1、避免双重征税协定；
　　　　 Double Taxation Agreement
　　□2、海运协定；
　　　　 Maritime Agreement

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