대한민국과 ()간의이중과세방지협약적용대상거주자증명서_Certification of Residence for the purpose of the Double Taxation Convention between the Republic of Korea and ()

[별지 제18호 서식]
발급번호
Issuing Number
대한민국과 ( )간의 이중과세방지협약 적용대상 거주자증명서
Certification of Residence for the purpose of the Double Taxation Convention
between the Republic of Korea and ()

1. 소득자
Beneficiary

①주소
Address

②상호
Name of Company
(Fill in if the recipient is not individual)

③성명
Name

④사업자등록번호(주민등록번호)
Taxpayer Identification Number
(Resident Registration Number)

2. 소득
Income
⑤대상소득
Type of
Income
⑥소득지급(예정)일
Date of Payment
or Due date
⑦소득지급자
Name of the
Payer
⑧원금 또는
투자금액
Principals or Investments
⑨계산기간
Accrual
period of
Income
⑩소득금액
Gross
Amount of
Income
⑪납부(환급)세액
Tax Payable
(Refund)
이자
Interest,
Profit sharing bonds

배당
Dividends

사용료
Royalties

위와 같이 증명합니다.
The Commissioner hereby certifies the above.
년월일
Year Month Day

국세청장 위임에 의하여 () 세무서장 (인)
For the Commissioner of the Director of () District Tax Office Official
National Tax Administration Stamp

22226-71811민 210㎜×297㎜
’96.1.30제정 (신문용지54g/㎡)

[hwp/doc/pdf]대한민국과 ()간의이중과세방지협약적용대상거주자증명서_Certification of Residence for the purpose of the Double Taxation Convention between the Republic of Korea and ()