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Societatea ......................

The company
(denumirea complet a solicitantului persoan juridic)
(full name of the applicant legal person)
Codul de identificare fiscal nr. .
Tax identification code no.
Localitatea ............................................................................................
City

Nr. i data nregistrrii la autoritatea fiscal


No. and date of registration at the tax authority

Str. ..................................................................., nr. ..............................


Street
no.

./

Telefon ..................................................................................................
Phone

CERERE1
APPLICATION
pentru eliberarea certificatului de reziden fiscal
for the issuance of the certificate of tax residence
privind aplicarea Conveniei/Acordului de evitare a dublei impuneri
in order to apply the Convention/Agreement for the avoidance of double taxation
dintre Romnia i .............................................................................................., pentru persoane juridice romne
between Romania and
for Romanian legal persons
(denumirea statului cu care Romnia are ncheiat convenie/acord)
(name of the State that has a Convention/Agreement concluded with Romania)

Societatea ............................................................................................................................................................, rezident n Romnia,


The company
resident in Romania
(denumirea complet a solicitantului persoan juridic)
(full name of the applicant legal person)
cu sediul n localitatea .............................................., adresa .................................................................................................................................,
with the head office located in
address
sectorul/judeul .................., deintoare a certificatului de nregistrare la registrul comertului nr. , eliberat la data de
sector/county
holder of the certificate of registration at the trade register no.
issued on
i avnd codul de identificare fiscal nr. ....................................................................., atribuit n data de ...........................................................,
and having the tax identification code no.
assigned on
solicit, n baza art. 7 coroborat cu art. 118 din Codul fiscal, eliberarea certificatului de reziden fiscal pe anul/perioada ....,
I hereby request, based on art. 7 and on aricle 118 of the Fiscal Code, the issuance of the certificate of tax residence for the year/period
n vederea aplicrii prevederilor Conveniei/Acordului de evitare a dublei impuneri dintre Romnia i ...
in order to apply the provisions of the Convention/Agreement
(denumirea statului cu care Romnia
for the avoidance of double taxation between Romania and
are ncheiat convenie/acord)
(name of the State that has a Convention/
Agreement concluded with Romania)

Reprezentantul firmei: ..............................................................................


The representative of the company
Semntura: .................................................................................................
Signature
Funcia: ......................................................................................................
Title
(funcia persoanei autorizate s reprezinte persoana juridic)
(title of the person authorized to represent the legal person)
Data: ......................................
Date

tampila:
Stamp

Cererea referitoare la eliberarea certificatului se depune la organul fiscal competent n a crui eviden contribuabilul este nregistrat,
potrivit legii.
The application regarding the issuance of the certificate shall be submitted to the competent tax authority where the taxpayer is registered,
according to the law.