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0901-R Tax Treaty Relief Application for Royalty Income

BIR application form for tax treaty relief for royalty income

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Application for
Royalty Income

Republika ng Pilipinas
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas

BIR Form No.

0901-R
Version 1.0 February 2010

Date of Application

Part I

TAX TREATY INFORMATION

1

Fill in all applicable spaces. Mark all appropriate boxes with "NOT APPLICABLE" if no appropriate response.
2A

Philippines Tax Convention with

2C

Preferential Tax Rate

2B

Article Invoked

%

INCOME EARNER

Part II

Taxpayer's Identification Number

3 Taxpayer's
Name 3A

3B

4 Foreign 4
Address
No. (Include Building Name)

Street

No. (Include Building Name)

City

Street

Country

Zip Code

City/Province

Zip Code

5 Local
5
Address

6 Business
Phone Number

District/Municipality

6A

6B

6C

Area/Access Code

Fax Number
Taxpayer's Identification Number

7 Local Representative in the Philippines, if any:
Name 7A

7B
0 0

0

8 Local 8A
Address
No. (Include Building Name)
9 Business
Phone Number

Street

District/Municipality

9A

City/Province

9B

Zip Code

9C

Area/Access Code

Fax Number
Taxpayer's Identification Number

10 Permanent Establishment / Fixed Base in the Philippines, if any:
Name 10A

10B

11
11 Local
Address
No. (Include Building Name)

Street

District/Municipality

City/Province

Zip Code

PAYOR OF INCOME

Part III

Taxpayer's Identification Number

13 Taxpayer's
Name 13A

13B
0 0

14
14 Local
Address
No. (Include Building Name)

Street

District/Municipality

City/Province

Zip Code

15 Registration with Board of Investments (BOI), if any:
15

Preferred

PART IV

Pioneer

Others (Specify)

DETAILS OF TRANSACTION
Date of Transaction

Terms

Consideration

Date of Payment

16

PART V

PERJURY DECLARATION

I/We declare, under the penalties of perjury, that this application has been made in good faith,
and that the representations incuding the accompanying documents have been verified by me/us and to the
best of my/our knowledge, belief, and information are correct, complete and true account of the
transaction/s subject of this application.

(Signature of Applicant/Representative over printed name)

Title/Position of Signatory

Stamp of BIR Receiving Office and
Date of Receipt

ITAD Filing Reference No.:
g

0

Part VI

DOCUMENTARY REQUIREMENTS

REMARKS

GENERAL DOCUMENTS
1 Proof of Residency
Original copy of consularized certification issued by the tax authority of the country of the income earner to the
effect that such income earner is a resident of such country for purposes of the tax treaty being invoked in the tax
year concerned.
2 Articles of Incorporation (For income earner other than individual)
Photocopy of the Articles of Incorporation (AOI) (or equivalent Fact of Establishment /Creation /Organization)
of the income earner with the original copy of consularized certification from the issuing agency, office or
authority that the copy of Articles of Incorporation (AOI) (or equivalent Fact of Establishment /Creation
/Organization) is a faithful reproduction or photocopy.
3 Special Power of Attorney
A. If applicant/filer is the withholding agent of the income earner or the local representative in the Philippines of
the income earner i. Original copy of a consularized Special Power of Attorney (SPA) or a consularized written authorization
duly executed by the income earner authorizing its withholding agent or local representative in the
Philippines to file tax treaty relief application.
B. If applicant/filer is the local representative of the withholding agent of the income earner i. Original copy of a consularized Special Power of Attorney (SPA) or a consularized written authorization
duly executed by the income earner authorizing its withholding agent or local representative in the
Philippines to file tax treaty relief application; and
ii Original copy of Letter of Authorization from the withholding agent authorizing local representative to file
the tax treaty relief application
4 Certificate of Business Presence in the Philippines
a. For Corporation or Partnership - Original copy of certification from the Philippine Securities and
Exchange Commission that income recipient is/is not registered to engage in business in the Philippines
b. For Individual - Original copy of a certification from the Department of Trade and Industry that the income
earner is not registered to engage in business in the Philippines
5 Certificate of No Pending Case
Original copy of a sworn statement providing information on whether the issue(s) or transaction involving
directly or indirectly the same taxpayer(s) which is/are the subject of the request for ruling is/are under
investigation; covered by an on-going audit, administrative protest, claim for refund or issuance of tax credit
certificate, collection proceedings, or subject of a judicial appeal
DOCUMENTS SPECIFIC TO ROYALTY INCOME
1 Royalty Agreement, Technology Transfer Agreeemnt, or Licensing Agreement
Original or certified copy of a duly notarized Royalty Agreement, Technology Transfer Agreement, or Licensing
Agreement.
2 Board of Investments (BOI) Registration, if applicable
Certified copy of Board of Investments registration of the payor of the royalties including a Sworn Statement that
such registration has not been cancelled at the time of the transaction.
3 Philippine Economic Zone Authoirty (PEZA) Registration, if applicable
Certified copy of the registration of the payor of the income or withholding agent with the Philippine Economic
Zone Authority (PEZA) of the payor of the royalties including a Sworn Statement that such registration has not
been cancelled at the time of the transaction.
4 Interlectual Property Office (IPO), if applicable
Certified copy of Intellectual Property Office (IPO) registration.
BIR FORM NO. 0901 - R
Guidelines and Instructions
This form shall be duly accomplished in (3) three copies which must be signed by the applicant who may either be the income
earner or the duly authorized representative of the income earner. All fields must be mandatorily filled-up. If "NOT APPLICABLE" or
"NONE" is/are the appropriate response, the same has/have to be clearly indicated in the corresponding field.
This form together with all the necesary documents mentioned in Part VI shall be submitted only to and received by the
International Tax Affairs Division of the Bureau of Internal Revenue. Filing should always be made BEFORE the transaction. Transaction
for purposes of filing the Tax Treaty Relief Application (TTRA) shall mean before the occurrence of the first taxable event.
First taxable event shall mean the first or the only time when the income payor is required to withhold the income tax thereon or
should have withheld taxes thereon had the transaction been subjected to tax.
Failure to properly file the TTRA with ITAD within the period prescribed herein shall have the effect of disqualifying the TTRA
under this RMO.
 
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