Withholding Tax Form （代扣所得税表） English Language Word or Term Chinese Language Word or Term INDIVIDUAL INCOME TAX WITHHOLDING RETURN 扣缴个人所得税报告表 Withholding agent’s file number 扣缴义务人编码 Date of filing 填表日期 Day 日 Month 月 Year 年 Monetary Unit 金额单位 RMB Yuan 人民币 元 This return is designed in accordance with the provisions of Article 9 of INDIVIDUAL INCOME TAX LAW OF THE PEOPLE’S REPUBLIC OF CHINA. The withholding agents should turn the tax withheld over to the State Treasury and file the return with the local tax authorities within seven days after the end of the taxable month. 根据《中华人民共和国个人所得税法》第九条的规定，制定本表，扣缴义务人应将本月扣缴的税款在次月七日内缴入国库，并向当地税务机关报送本表。 Withholding agent’s name 扣缴义务人名称 Address 地址 Telephone Number 电话 Tax payer’s name 纳税义务人姓名 Tax payer’s file number 纳税人编码 Unit’s name and Address 工作单位及地址 Categories of income 所得项目 Income period 所得时间 Revenue 收入额 Renminbi （RMB） 人民币 Foreign currency 外币 Name of currency 货币名称 Amount 金额 Exchange rate 外汇牌价 Renminbi （RMB）converted into 折合人民币 Total 人民币合计 Deductions 减费用额 Taxable Income 应纳税所得额 Tax rate 税率 Quick calculation deduction 速算扣除数 Amount of tax withheld 扣缴所得税额 Tax certificate number 完税证字号 Date of tax payment 纳税日期 In case the tax certificate is filled out by withholding agent, this return should be submitted together with 如果由扣缴义务人填写完税证，应在送此表时附完税证副联——份 Withholding total amount yuan 合计扣缴金额——元 Declaration by Withholding agent 扣缴义务人声明 I declare that the return is filled out in accordance with the INDIVIDUAL INCOME TAX LAW OF THE PEOPLE’S REPUBLIC OF CHINA, and I believe that the Statements contained in this return are true, correct and complete. 我声明：此扣缴申报报表是根据《中华人民共和国个人所得税法》的规定填报的，我确信它是真实的，可靠的，完整的。 Signature 签字 General Accountant （signature） 会计主管人签字 Responsible officer （signature） 负责人签字 Withholding agent （seal） 扣缴单位（或个人）盖章 For official use 由以下税务机关填写