ANEXA 6 / ANNEX No 6

ROMNIA
MINISTERUL FINANELOR PUBLICE
Agenia Naional de Administrare Fiscal
(1) ______________________________________

Numr de operator date cu caracter personal

______________________________________
Adresa: _________________________
Address
E-mail:__________________________
E-mail address
Nr. i data eliberrii
No and date of issuance
_________________/______________

CERTIFICAT
CERTIFICATE
de reziden fiscal privind aplicarea Conveniei/Acordului de evitare a dublei impuneri dintre
of tax residence in order to apply the Convention/Agreement for the avoidance
of double taxation between
Romnia i (2) ______________________________________________________________,
Romania and
pentru persoane fizice rezidente n Romnia care desfoar activitate independent
for individuals resident in Romania carrying on an independent activity
Organul fiscal (1) ______________________________________________________________,
The tax authority
n baza cererii nregistrate cu nr. i data _______________________/________________,
based on the application registered with no and date
atest c domnul/doamna (3) ________________________________________________,
hereby certifies that Mr./Mrs.
cu domiciliul fiscal n localitatea _____________________________________,
with the fiscal domicile located in
adresa ____________________________________________________, sectorul/judeul ________________________,
address
sector/county
i avnd codul numeric personal/numrul de identificare fiscal _________________________________,
and having the personal identification number/tax identification number
este rezident() n Romnia i i sunt aplicabile prevederile Conveniei/Acordului de evitare a dublei impuneri dintre
is resident in Romania and he/she is subject to the provisions of the Convention/Agreement for the avoidance of double
taxation between
Romnia i (2) ____________________________________________________________________ .
Romania and
Persoana rezident n Romnia desfoar activitate independent
The individual resident in Romania carries on an independent activity
n cadrul _________________________________________________________________,
at
(denumire)
(name)

avnd codul de identificare fiscal nr. __________________________________________ .

having the tax identification code no
Prezentul certificat eliberat la data de ________________________.
This certificate issued on
este valabil pentru anul/perioada (4) ________________________ .
is valid for the year/period
Numele i prenumele: _____________________________________
Name and first name
Semntura: ____________________________
Signature
Funcia (5): ____________________________
Title
tampila:
Stamp

PRECIZRI
EXPLANATIONS
A) Certificatul se completeaz i se elibereaz de ctre organul fiscal competent, potrivit legii.
The certificate shall be filled in and issued by the competent tax authority, according to the law.
B) Explicaii privind completarea certificatului:
How to fill in the certificate:
(1) Se nscrie denumirea organului fiscal, avndu-se n vedere precizrile de la lit. A).
The name of the tax authority shall be filled in, taking into account the explanations from letter A).
(2) Se nscrie denumirea statului cu care Romnia are ncheiat/ncheiat convenie/acord de evitare a dublei
impuneri.
The name of the state that has a Convention/Agreement for the avoidance of double taxation concluded with
Romania shall be filled in.
(3) Se nscriu numele i prenumele persoanei fizice rezidente n Romnia care solicit certificatul.
The name and first name of the individual resident in Romania who has applied for the certificate shall be filled
in.
(4) Se nscrie anul/perioada pentru care este valabil certificatul.
The year/period for which the certificate is valid shall be filled in.
(5) Certificatul va fi semnat de conductorul organului fiscal, potrivit competenelor.
The certificate shall be signed by the head of the tax authority, according to his/her responsibility.
C) Certificatul se completeaz n 2 (dou) exemplare, dintre care unul se nmneaz persoanei fizice rezidente n
Romnia care desfoar activitate independent sau reprezentantului/mputernicitului acesteia i unul rmne la organul
fiscal emitent.
The Certificate shall be filled in in duplicate, one is handed in to the individual resident in Romania carrying on an
independent activity or to his/her representative/commissioner and the other stays with the issuing tax authority.