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
