Objava Priloga uz Pravilnik o porezu na dobit

Objava Priloga uz Pravilnik o porezu na dobit Upute za korištenje Elektronička pošta Početna stranica Objava Priloga uz Pravilnik o porezu na dobit NN 1/2001 (5.1.2001.), Objava Priloga uz Pravilnik o porezu na dobit 30 Uz Pravilnik o porezu na dobit objav­ljenom u »Narodnim novinama«, broj 132 od

1. prosinca
2. godine, greškom nije objav­ljen prilog obrazac-licence i prilog obrazac-kamate, pa se uz citirani Pravilnik objav­ljuje PRILOG OBRAZAC-LICENCE OBRAZAC-KAMATE UZ PRAVILNIK O POREZU NA DOBIT Uz Pravilnik o porezu na dobit objav­ljuje se obrazac-licence primjerak 1 do 4 i Upute za popu­njava­nje: Licence, te obrazac-kamate primjerak 1 do 4 i Upute za popu­njava­nje: Kamate. Urbroj: 50501-01-8 Zagreb,
3. siječ­nja
4. Glavna urednica »Narodnih novina« S­nježana Bagić, v. r. OBRAZAC-LICENCE FORM - ROYALTIES PRIMJERAK 1 - za podnositelja zahtjeva- COPY 1 - for the claimant - R E P U B L I K A H R V A T S K A MINISTARSTVO FINANCIJA – POREZNA UPRAVA THE REPUBLIC OF CROATIA MINISTRY OF FINANCE – TAX ADMINISTRATION ZAHTJEV ZA UMANJENJE POREZNE OBVEZE, IZUZIMANJE OD POREZA ILI POVRAT VIŠE PLAĆENOG POREZA NA LICENCE I SLIČNA DAVANJA PREMA UGOVORU O IZBJEGAVANJU DVOSTRUKOG OPOREZIVANJA IZMEĐU REPUBLIKE HRVATSKE I ……………………………… ("Narodne novine – Međunarodni ugovori", broj: ..…) APPLICATION FOR TAX RELIEF, TAX EXEMPTION OR TAX REFUND FOR ROYALTIES UNDER THE AGREEMENT FOR THE AVOIDANCE OF DOUBLE TAXATION BETWEEN THE REPUBLIC OF CROATIA AND ......................................... ("Official Gazette – International Agreements", number: ..…) Podaci iz ovog Zahtjeva potrebni su zbog primjene članka
5. Zakona o porezu na dohodak ("Narodne novine", broj 127/00.) i članka
6. Zakona o porezu na dobit ("Narodne novine", broj 127/00.) – The data to be given in this application are requested under Article 23 of Income Tax Act ("Official Gazette", number 127/00) and Article 22 of Profit Tax Act ("Official Gazette", number 127/00) I. PODACI O StjecateljU licence – INFORMATION ON THE LICENSEE: Ime i prezime / naziv tvrtke – Full name / business name: .................................................................................................................... Pravni oblik - Legal form: ....................................................................................................................................................................... Broj (JMBG ili matični broj) - Number (identification number / tax number): .......................................................................................... Zanimanje / djelatnost – Occupation: ..................................................................................................................................................... Prebivalište / sjedište – Address: ........................................................................................................................................................... Ulica i broj – Street and number: .................................................................................................................................................... Poštanski broj – Postal code: …………………………………….Grad – City: .............………………………………………………… Država – State: ............................................................................................................................................................................... II. PODACI O PODNOSITELJU ZAHTJEVA - DavateljU licence – INFORMATION ON THE CLAIMANT – LICENSor: Ime i prezime / naziv tvrtke – Full name / business name: .................................................................................................................... Pravni oblik - Legal form: ....................................................................................................................................................................... Broj – Number: ....................................................................................................................................................................................... Zanimanje / djelatnost – Occupation: Prebivalište / sjedište – Address: ........................................................................................................................................................... Ulica i broj – Street and number: .................................................................................................................................................... Poštanski broj – Postal code: ......................................Grad – City: ................................................................................………… Država – State: ............................................................................................................................................................................... Ime i prezime / naziv zastupnika (ako ga ima) – Name of the representative (if any): .......................................................................... Prebivalište / sjedište – Address: ........................................................................................................................................................... III. Predmet ugovora o licenci – SUBJECT MATTER OF LICENCE: 3.
7. Prava intelektualnog vlasništva – Intellectual property rights 3.1.
8. Vrste prava intelektualnog vlasništva – Form of intellectual property right: ........................................................................................................................................................................................................ ........................................................................................................................................................................................................ 3.1.
9. Registracija prava intelektualnog vlasništva – Registration of intellectual property right: Država registracije – Country of registration: ................................................................................................................................. Broj registracije – Registration number: ......................................................................................................................................... Datum registracije – Date of registration: ....................................................................................................................................... 3.1.
10. Nositelj prava intelektualnog vlasništva prema registru – Registered owner of intellectual property right: Ime i prezime / naziv tvrtke – Full name / business name: ............................................................................................................ Pravni oblik - Legal form: ............................................................................................................................................................... Zanimanje / djelatnost – Occupation: ............................................................................................................................................. Prebivalište / sjedište – Address: ................................................................................................................................................... Ulica i broj – Street and number: ........................................................................................................................................... Poštanski broj – Postal code: .................................... Grad – City: ..........................................................................………. Država – State: ..................................................................................................................................................................... 3.
11. Prava na korištenje pokretnina (između ostalog leasing-ugovori) – Right to use movable property (under a leasing or another agreement) 3.2.
12. Vrste pokretnina – Type of movable property:............................................................................................................................. ........................................................................................................................................................................................................ 3.3 Autorska prava (prava koja ne spadaju pod točku 3.1) – Copyrights (other than those under paragraph 3.1) 3.3.
13. Vrste autorskog prava – Form of copyright: ................................................................................................................................. 3.3.
14. Naziv zaštićenog djela – Title of protected work: ........................................................................................................................ 3.3.
15. Autor - Author Ime – Name: ................................................................................................................................................................................... Prezime – Surname: ....................................................................................................................................................................... Prebivalište / sjedište – Address: Ulica i broj – Street and number: ........................................................................................................................................... Poštanski broj – Postal code: ..........................................Grad – City: ..........................................................................…… Država – State: ..................................................................................................................................................................... 3.3.
16. Davatelj licence ovlašten je za davanje licence na temelju – The licensor is authorized to grant licence by virtue of: .............................................................................................................................................................................................................. IV. PODACI O DOHOTKU – DESCRIPTION OF THE INCOME: Ukupan iznos dohotka– Total amount of income: .................................................................................................................................. Datum isplate – Date of payment: .......................................................................................................................................................... Ukupan iznos poreza – Total amount of tax: ........................................................................................................................................ V. PRILOŽENI DOKUMENTI (broj i naziv) – Documents attached (number and title):................................... ............................................................................................................................................................................................................... VI. NAČIN POVRATA VIŠE PLAĆENOG POREZA – procedure of the refund: U Republici Hrvatskoj ili u – In the Republic of Croatia or in: ................................................................................................................. Na broj računa – To the account number: ............................................................................................................................................. Kod (banka) – With the (Bank): ............................................................................................................................................................ Otvorenog na ime – Opened in the name of: ........................................................................................................................................ VII. IZJAVA PODNOSITELJA ZAHTJEVA – STATEMENT OF THE CLAIMANT: Potpisnik jamči da su gore navedeni podaci istiniti te da podnositelj zahtjeva, naveden pod točkom II., ispunjava slijedeće uvjete – The undersigned certifies that the beneficial owner mentioned under II fulfills the following conditions:
17. Stvarni je korisnik gore navedenog dohotka – He is the beneficial owner of the mentioned income,
18. Dohodak u smislu navedenog Ugovora o izbjegavanju dvostrukog oporezivanja nije ostvaren kroz djelatnost registriranu u Republici Hrvatskoj – He did not derive income, as defined in the mentioned Agreement for the avoidance of double taxation, through the activity registered in the Republic of Croatia, Poznato mi je da Porezna uprava Republike Hrvatske može poreznom tijelu u državi rezidentnosti podnositelja zahtjeva davati podatke o sadržaju ovog zahtjeva – I am aware of the fact that the Croatian Tax Administration can disclose the information given in this Application to the tax authorities in the country of residence of the claimant. .................................................... .......................................... Mjesto i datum – Place and date Potpis - Signature VIII. POTVRDA POREZNOG TIJELA DRŽAVE REZIDENTNOSTI PODNOSITELJA ZAHTJEVA – CERTIFICATE OF TAX AUTHORITY OF CLAIMANT´S COUNTRY OF RESIDENCE: Podnositelj zahtjeva je rezident .................................. prema članku ............... Ugovora o izbjegavanju dvostrukog oporezivanja između Republike Hrvatske i .................................... – The claimant is the resident of ................................... under Article .......... of the Agreement for the avoidance of double taxation between the Republic of Croatia and .................................... .................................................... ..................................................... .................................................... Mjesto i datum - Place and date Pečat - Stamp Potpis - Signature PRIMJERAK 2 - za isplatitelja dohotka - COPY 2 - for the payer of the income - R E P U B L I K A H R V A T S K A MINISTARSTVO FINANCIJA – POREZNA UPRAVA THE REPUBLIC OF CROATIA MINISTRY OF FINANCE – TAX ADMINISTRATION ZAHTJEV ZA UMANJENJE POREZNE OBVEZE, IZUZIMANJE OD POREZA ILI POVRAT VIŠE PLAĆENOG POREZA NA LICENCE I SLIČNA DAVANJA PREMA UGOVORU O IZBJEGAVANJU DVOSTRUKOG OPOREZIVANJA IZMEĐU REPUBLIKE HRVATSKE I ……………………………… ("Narodne novine – Međunarodni ugovori", broj: ..…) APPLICATION FOR TAX RELIEF, TAX EXEMPTION OR TAX REFUND FOR ROYALTIES UNDER THE AGREEMENT FOR THE AVOIDANCE OF DOUBLE TAXATION BETWEEN THE REPUBLIC OF CROATIA AND ......................................... ("Official Gazette – International Agreements", number: ..…) Podaci iz ovog Zahtjeva potrebni su zbog primjene članka
19. Zakona o porezu na dohodak ("Narodne novine", broj 127/00.) i članka
20. Zakona o porezu na dobit ("Narodne novine", broj 127/00.) – The data to be given in this application are requested under Article 23 of Income Tax Act ("Official Gazette", number 127/00) and Article 22 of Profit Tax Act ("Official Gazette", number 127/00) I. PODACI O StjecateljU licence – INFORMATION ON THE LICENSEE: Ime i prezime / naziv tvrtke – Full name / business name: .................................................................................................................... Pravni oblik - Legal form: ....................................................................................................................................................................... Broj (JMBG ili matični broj) - Number (identification number / tax number): .......................................................................................... Zanimanje / djelatnost – Occupation: ..................................................................................................................................................... Prebivalište / sjedište – Address: ........................................................................................................................................................... Ulica i broj – Street and number: .................................................................................................................................................... Poštanski broj – Postal code: ...................................................Grad – City: .................................................................................. Država – State: ............................................................................................................................................................................... II. PODACI O PODNOSITELJU ZAHTJEVA - DavateljU licence – INFORMATION ON THE CLAIMANT – LICENSOR: Ime i prezime / naziv tvrtke – Full name / business name: .................................................................................................................... Pravni oblik - Legal form: ....................................................................................................................................................................... Broj – Number: ....................................................................................................................................................................................... Zanimanje / djelatnost – Occupation: Prebivalište / sjedište – Address: ........................................................................................................................................................... Ulica i broj – Street and number: .................................................................................................................................................... Poštanski broj – Postal code: .............................................Grad – City: ................................................................................…… Država – State: ............................................................................................................................................................................... Ime i prezime / naziv zastupnika (ako ga ima) – Name of the representative (if any): .......................................................................... Prebivalište / sjedište – Address: ........................................................................................................................................................... III. Predmet ugovora o licenci – SUBJECT MATTER OF LICENCE: 3.
21. Prava intelektualnog vlasništva – Intellectual property rights 3.1.
22. Vrste prava intelektualnog vlasništva – Form of intellectual property right: ........................................................................................................................................................................................................ ........................................................................................................................................................................................................ 3.1.
23. Registracija prava intelektualnog vlasništva – Registration of intellectual property right: Država registracije – Country of registration: ................................................................................................................................. Broj registracije – Registration number: ......................................................................................................................................... Datum registracije – Date of registration: ....................................................................................................................................... 3.1.
24. Nositelj prava intelektualnog vlasništva prema registru – Registered owner of intellectual property right: Ime i prezime / naziv tvrtke – Full name / business name: ............................................................................................................ Pravni oblik - Legal form: ............................................................................................................................................................... Zanimanje / djelatnost – Occupation: ............................................................................................................................................. Prebivalište / sjedište – Address: ................................................................................................................................................... Ulica i broj – Street and number: ........................................................................................................................................... Poštanski broj – Postal code: ................................................Grad – City: ............................................................................ Država – State: ..................................................................................................................................................................... 3.
25. Prava na korištenje pokretnina (između ostalog leasing-ugovori) – Right to use movable property (under a leasing or an other agreement) 3.2.
26. Vrste pokretnina – Type of movable property:............................................................................................................................. ........................................................................................................................................................................................................ 3.3 Autorska prava (prava koja ne spadaju pod točku 3.1) – Copyrights (other than those under paragraph 3.1) 3.3.
27. Vrste autorskog prava – Form of copyright: ................................................................................................................................. 3.3.
28. Naziv zaštićenog djela – Title of protected work: ........................................................................................................................ 3.3.
29. Autor - Author Ime – Name: ................................................................................................................................................................................... Prezime – Surname: ....................................................................................................................................................................... Prebivalište / sjedište – Address: Ulica i broj – Street and number: ........................................................................................................................................... Poštanski broj – Postal code: ...............................................Grad – City: ............................................................................ Država – State: ..................................................................................................................................................................... 3.3.
30. Davatelj licence ovlašten je za davanje licence na temelju – The licensor is authorized to grant licence by virtue of: .............................................................................................................................................................................................................. IV. PODACI O DOHOTKU – DESCRIPTION OF THE INCOME: Ukupan iznos dohotka– Total amount of income: .................................................................................................................................. Datum isplate – Date of payment: .......................................................................................................................................................... Ukupan iznos poreza – Total amount of tax: ........................................................................................................................................ V. PRILOŽENI DOKUMENTI (broj i naziv) – Documents attached (number and title):.................................................................…. ............................................................................................................................................................................................................... VI. NAČIN POVRATA VIŠE PLAĆENOG POREZA – procedure of the refund: U Republici Hrvatskoj ili u – In the Republic of Croatia or in: ................................................................................................................. Na broj računa – To the account number: ..........................................................................................................................……………. Kod (banka) – With the (Bank):................................................................................................................................................ Otvorenog na ime – Opened in the name of: ......................................................................................................................................... VII. IZJAVA PODNOSITELJA ZAHTJEVA – STATEMENT OF THE CLAIMANT: Potpisnik jamči da su gore navedeni podaci istiniti te da podnositelj zahtjeva, naveden pod točkom II., ispunjava slijedeće uvjete – The undersigned certifies that the beneficial owner mentioned under II fulfills the following conditions:
31. Stvarni je korisnik gore navedenog dohotka – He is the beneficial owner of the mentioned income,
32. Dohodak u smislu navedenog Ugovora o izbjegavanju dvostrukog oporezivanja nije ostvaren kroz djelatnost registriranu u Republici Hrvatskoj – He did not derive income, as defined in the mentioned Agreement for the avoidance of double taxation, through the activity registered in the Republic of Croatia, Poznato mi je da Porezna uprava Republike Hrvatske može poreznom tijelu u državi rezidentnosti podnositelja zahtjeva davati podatke o sadržaju ovog zahtjeva – I am aware of the fact that the Croatian Tax Administration can disclose the information given in this Application to the tax authorities in the country of residence of the claimant. .................................................... .......................................... Mjesto i datum – Place and date Potpis - Signature VIII. POTVRDA POREZNOG TIJELA DRŽAVE REZIDENTNOSTI PODNOSITELJA ZAHTJEVA – CERTIFICATE OF TAX AUTHORITY OF CLAIMANT´S COUNTRY OF RESIDENCE: Podnositelj zahtjeva je rezident .................................. prema članku ............... Ugovora o izbjegavanju dvostrukog oporezivanja između Republike Hrvatske i .................................... – The claimant is the resident of ................................... under Article .......... of the Agreement for the avoidance of double taxation between the Republic of Croatia and .................................... .................................................... ..................................................... .................................................... Mjesto i datum - Place and date Pečat - Stamp Potpis - Signature PRIMJERAK 3 - za Poreznu upravu Republike Hrvatske - COPY 3 - for the Tax Administration of the Republic of Croatia - R E P U B L I K A H R V A T S K A MINISTARSTVO FINANCIJA – POREZNA UPRAVA THE REPUBLIC OF CROATIA MINISTRY OF FINANCE – TAX ADMINISTRATION ZAHTJEV ZA UMANJENJE POREZNE OBVEZE, IZUZIMANJE OD POREZA ILI POVRAT VIŠE PLAĆENOG POREZA NA LICENCE I SLIČNA DAVANJA PREMA UGOVORU O IZBJEGAVANJU DVOSTRUKOG OPOREZIVANJA IZMEĐU REPUBLIKE HRVATSKE I ……………………………… ("Narodne novine – Međunarodni ugovori", broj: ..…) APPLICATION FOR TAX RELIEF, TAX EXEMPTION OR TAX REFUND FOR ROYALTIES UNDER THE AGREEMENT FOR THE AVOIDANCE OF DOUBLE TAXATION BETWEEN THE REPUBLIC OF CROATIA AND ......................................... ("Official Gazette – International Agreements", number: ..…) Podaci iz ovog Zahtjeva potrebni su zbog primjene članka
33. Zakona o porezu na dohodak ("Narodne novine", broj 127/00.) i članka
34. Zakona o porezu na dobit ("Narodne novine", broj 127/00.) – The data to be given in this application are requested under Article 23 of Income Tax Act ("Official Gazette", number 127/00) and Article 22 of Profit Tax Act ("Official Gazette", number 127/00) I. PODACI O StjecateljU licence – INFORMATION ON THE LICENSEE: Ime i prezime / naziv tvrtke – Full name / business name: .................................................................................................................... Pravni oblik - Legal form: ....................................................................................................................................................................... Broj (JMBG ili matični broj) - Number (identification number / tax number): .......................................................................................... Zanimanje / djelatnost – Occupation: ..................................................................................................................................................... Prebivalište / sjedište – Address: ........................................................................................................................................................... Ulica i broj – Street and number: .................................................................................................................................................... Poštanski broj – Postal code: ..................................................Grad – City: .................................................................................. Država – State: ............................................................................................................................................................................... II. PODACI O PODNOSITELJU ZAHTJEVA - DavateljU licence – INFORMATION ON THE CLAIMANT – LICENSOR: Ime i prezime / naziv tvrtke – Full name / business name: .................................................................................................................... Pravni oblik - Legal form: ....................................................................................................................................................................... Broj – Number: ....................................................................................................................................................................................... Zanimanje / djelatnost – Occupation: Prebivalište / sjedište – Address: ........................................................................................................................................................... Ulica i broj – Street and number: .................................................................................................................................................... Poštanski broj – Postal code: .................................................Grad – City: .................................................................................. Država – State: ............................................................................................................................................................................... Ime i prezime / naziv zastupnika (ako ga ima) – Name of the representative (if any): .......................................................................... Prebivalište / sjedište – Address: ........................................................................................................................................................... III. Predmet ugovora o licenci – SUBJECT MATTER OF LICENCE: 3.
35. Prava intelektualnog vlasništva – Intellectual property rights 3.1.
36. Vrste prava intelektualnog vlasništva – Form of intellectual property right: ........................................................................................................................................................................................................ ........................................................................................................................................................................................................ 3.1.
37. Registracija prava intelektualnog vlasništva – Registration of intellectual property right: Država registracije – Country of registration: ................................................................................................................................. Broj registracije – Registration number: ......................................................................................................................................... Datum registracije – Date of registration: ....................................................................................................................................... 3.1.
38. Nositelj prava intelektualnog vlasništva prema registru – Registered owner of intellectual property right: Ime i prezime / naziv tvrtke – Full name / business name: ............................................................................................................ Pravni oblik - Legal form: ............................................................................................................................................................... Zanimanje / djelatnost – Occupation: ............................................................................................................................................. Prebivalište / sjedište – Address: ................................................................................................................................................... Ulica i broj – Street and number: ........................................................................................................................................... Poštanski broj – Postal code: ................................................Grad – City: ............................................................................ Država – State: ..................................................................................................................................................................... 3.
39. Prava na korištenje pokretnina (između ostalog leasing-ugovori) – Right to use movable property (under a leasing or an other agreement) 3.2.
40. Vrste pokretnina – Type of movable property:............................................................................................................................. ........................................................................................................................................................................................................ 3.3 Autorska prava (prava koja ne spadaju pod točku 3.1) – Copyrights (other than those under paragraph 3.1) 3.3.
41. Vrste autorskog prava – Form of copyright: ................................................................................................................................. 3.3.
42. Naziv zaštićenog djela – Title of protected work: ........................................................................................................................ 3.3.
43. Autor - Author Ime – Name: ................................................................................................................................................................................... Prezime – Surname: ....................................................................................................................................................................... Prebivalište / sjedište – Address: Ulica i broj – Street and number: ........................................................................................................................................... Poštanski broj – Postal code: ...................................................Grad – City: ................................................................…….. Država – State: ..................................................................................................................................................................... 3.3.
44. Davatelj licence ovlašten je za davanje licence na temelju – The licensor is authorized to grant licence by virtue of: .............................................................................................................................................................................................................. IV. PODACI O DOHOTKU – DESCRIPTION OF THE INCOME: Ukupan iznos dohotka– Total amount of income: .................................................................................................................................. Datum isplate – Date of payment: .......................................................................................................................................................... Ukupan iznos poreza – Total amount of tax: ........................................................................................................................................ V. PRILOŽENI DOKUMENTI (broj i naziv) – Documents attached (number and title):...................................................................... ............................................................................................................................................................................................................... VI. NAČIN POVRATA VIŠE PLAĆENOG POREZA – procedure of the refund: U Republici Hrvatskoj ili u – In the Republic of Croatia or in: ................................................................................................................. Na broj računa – To the account number: ....................................................................................................................................……. Kod (banka) – With the (Bank): ...................................................…………………………………………………………………………….. Otvorenog na ime – Opened in the name of: ......................................................................................................................................... VII. IZJAVA PODNOSITELJA ZAHTJEVA – STATEMENT OF THE CLAIMANT: Potpisnik jamči da su gore navedeni podaci istiniti te da podnositelj zahtjeva, naveden pod točkom II., ispunjava slijedeće uvjete – The undersigned certifies that the beneficial owner mentioned under II fulfills the following conditions:
45. Stvarni je korisnik gore navedenog dohotka – He is the beneficial owner of the mentioned income,
46. Dohodak u smislu navedenog Ugovora o izbjegavanju dvostrukog oporezivanja nije ostvaren kroz djelatnost registriranu u Republici Hrvatskoj – He did not derive income, as defined in the mentioned Agreement for the avoidance of double taxation, through the activity registered in the Republic of Croatia, Poznato mi je da Porezna uprava Republike Hrvatske može poreznom tijelu u državi rezidentnosti podnositelja zahtjeva davati podatke o sadržaju ovog zahtjeva – I am aware of the fact that the Croatian Tax Administration can disclose the information given in this Application to the tax authorities in the country of residence of the claimant. .................................................... .......................................... Mjesto i datum – Place and date Potpis - Signature VIII. POTVRDA POREZNOG TIJELA DRŽAVE REZIDENTNOSTI PODNOSITELJA ZAHTJEVA – CERTIFICATE OF TAX AUTHORITY OF CLAIMANT´S COUNTRY OF RESIDENCE: Podnositelj zahtjeva je rezident .................................. prema članku ............... Ugovora o izbjegavanju dvostrukog oporezivanja između Republike Hrvatske i .................................... – The claimant is the resident of ................................... under Article .......... of the Agreement for the avoidance of double taxation between the Republic of Croatia and .................................... .................................................... ..................................................... .................................................... Mjesto i datum - Place and date Pečat - Stamp Potpis - Signature VIII. NAPOMENE POREZNE UPRAVE REPUBLIKE HRVATSKE (ako ih ima) – CROATIAN TAX AUTHORITIES REMARKS (if any) PRIMJERAK 4 - za inozemno porezno tijelo - COPY 4 - for the foreign tax authotity - R E P U B L I K A H R V A T S K A MINISTARSTVO FINANCIJA – POREZNA UPRAVA THE REPUBLIC OF CROATIA MINISTRY OF FINANCE – TAX ADMINISTRATION ZAHTJEV ZA UMANJENJE POREZNE OBVEZE, IZUZIMANJE OD POREZA ILI POVRAT VIŠE PLAĆENOG POREZA NA LICENCE I SLIČNA DAVANJA PREMA UGOVORU O IZBJEGAVANJU DVOSTRUKOG OPOREZIVANJA IZMEĐU REPUBLIKE HRVATSKE I ……………………………… ("Narodne novine – Međunarodni ugovori", broj: ..…) APPLICATION FOR TAX RELIEF, TAX EXEMPTION OR TAX REFUND FOR ROYALTIES UNDER THE AGREEMENT FOR THE AVOIDANCE OF DOUBLE TAXATION BETWEEN THE REPUBLIC OF CROATIA AND ......................................... ("Official Gazette – International Agreements", number: ..…) Podaci iz ovog Zahtjeva potrebni su zbog primjene članka
47. Zakona o porezu na dohodak ("Narodne novine", broj 127/00.) i članka
48. Zakona o porezu na dobit ("Narodne novine", broj 127/00.) – The data to be given in this application are requested under Article 23 of Income Tax Act ("Official Gazette", number 127/00) and Article 22 of Profit Tax Act ("Official Gazette", number 127/00) I. PODACI O StjecateljU licence – INFORMATION ON THE LICENSEE: Ime i prezime / naziv tvrtke – Full name / business name: .................................................................................................................... Pravni oblik - Legal form: ....................................................................................................................................................................... Broj (JMBG ili matični broj) - Number (identification number / tax number): .......................................................................................... Zanimanje / djelatnost – Occupation: ..................................................................................................................................................... Prebivalište / sjedište – Address: ........................................................................................................................................................... Ulica i broj – Street and number: .................................................................................................................................................... Poštanski broj – Postal code: .....................................................Grad – City: .......................................................................……. Država – State: ............................................................................................................................................................................... II. PODACI O PODNOSITELJU ZAHTJEVA - DavateljU licence – INFORMATION ON THE CLAIMANT – LICENSOR: Ime i prezime / naziv tvrtke – Full name / business name: .................................................................................................................... Pravni oblik - Legal form: ....................................................................................................................................................................... Broj – Number: ....................................................................................................................................................................................... Zanimanje / djelatnost – Occupation: Prebivalište / sjedište – Address: ........................................................................................................................................................... Ulica i broj – Street and number: .................................................................................................................................................... Poštanski broj – Postal code: .....................................................Grad – City: ...........................................................................…. Država – State: ............................................................................................................................................................................... Ime i prezime / naziv zastupnika (ako ga ima) – Name of the representative (if any): .......................................................................... Prebivalište / sjedište – Address: ........................................................................................................................................................... III. Predmet ugovora o licenci – SUBJECT MATTER OF LICENCE: 3.
49. Prava intelektualnog vlasništva – Intellectual property rights 3.1.
50. Vrste prava intelektualnog vlasništva – Form of intellectual property right: ........................................................................................................................................................................................................ ........................................................................................................................................................................................................ 3.1.
51. Registracija prava intelektualnog vlasništva – Registration of intellectual property right: Država registracije – Country of registration: ................................................................................................................................. Broj registracije – Registration number: ......................................................................................................................................... Datum registracije – Date of registration: ....................................................................................................................................... 3.1.
52. Nositelj prava intelektualnog vlasništva prema registru – Registered owner of intellectual property right: Ime i prezime / naziv tvrtke – Full name / business name: ............................................................................................................ Pravni oblik - Legal form: ............................................................................................................................................................... Zanimanje / djelatnost – Occupation: ............................................................................................................................................. Prebivalište / sjedište – Address: ................................................................................................................................................... Ulica i broj – Street and number: ........................................................................................................................................... Poštanski broj – Postal code: ...................................................Grad – City: ........................................................................ Država – State: ..................................................................................................................................................................... 3.
53. Prava na korištenje pokretnina (između ostalog leasing-ugovori) – Right to use movable property (under a leasing or another agreement) 3.2.
54. Vrste pokretnina – Type of movable property:............................................................................................................................. ........................................................................................................................................................................................................ 3.3 Autorska prava (prava koja ne spadaju pod točku 3.1) – Copyrights (other than those under paragraph 3.1) 3.3.
55. Vrste autorskog prava – Form of copyright: ................................................................................................................................. 3.3.
56. Naziv zaštićenog djela – Title of protected work: ........................................................................................................................ 3.3.
57. Autor - Author Ime – Name: ................................................................................................................................................................................... Prezime – Surname: ....................................................................................................................................................................... Prebivalište / sjedište – Address: Ulica i broj – Street and number: ........................................................................................................................................... Poštanski broj – Postal code: ...................................................Grad – City: ......................................................................... Država – State: ..................................................................................................................................................................... 3.3.
58. Davatelj licence ovlašten je za davanje licence na temelju – The licensor is authorized to grant licence by virtue of: .............................................................................................................................................................................................................. IV. PODACI O DOHOTKU – DESCRIPTION OF THE INCOME: Ukupan iznos dohotka– Total amount of income: .................................................................................................................................. Datum isplate – Date of payment: .......................................................................................................................................................... Ukupan iznos poreza – Total amount of tax: ........................................................................................................................................ V. PRILOŽENI DOKUMENTI (broj i naziv) – Documents attached (number and title):...................................................................... ............................................................................................................................................................................................................... VI. NAČIN POVRATA VIŠE PLAĆENOG POREZA – procedure of the refund: U Republici Hrvatskoj ili u – In the Republic of Croatia or in: ................................................................................................................. Na broj računa – To the account number: ............................................................................................................................................. Kod (banka) – With the(Bank): ....................................................……………………………………………………………………………. Otvorenog na ime – Opened in the name of: ......................................................................................................................................... VII. IZJAVA PODNOSITELJA ZAHTJEVA – STATEMENT OF THE CLAIMANT: Potpisnik jamči da su gore navedeni podaci istiniti te da podnositelj zahtjeva, naveden pod točkom II., ispunjava slijedeće uvjete – The undersigned certifies that the beneficial owner mentioned under II fulfills the following conditions:
59. Stvarni je korisnik gore navedenog dohotka – He is the beneficial owner of the mentioned income,
60. Dohodak u smislu navedenog Ugovora o izbjegavanju dvostrukog oporezivanja nije ostvaren kroz djelatnost registriranu u Republici Hrvatskoj – He did not derive income, as defined in the mentioned Agreement for the avoidance of double taxation, through the activity registered in the Republic of Croatia, Poznato mi je da Porezna uprava Republike Hrvatske može poreznom tijelu u državi rezidentnosti podnositelja zahtjeva davati podatke o sadržaju ovog zahtjeva – I am aware of the fact that the Croatian Tax Administration can disclose the information given in this Application to the tax authorities in the country of residence of the claimant. .................................................... .......................................... Mjesto i datum – Place and date Potpis - Signature VIII. POTVRDA POREZNOG TIJELA DRŽAVE REZIDENTNOSTI PODNOSITELJA ZAHTJEVA – CERTIFICATE OF TAX AUTHORITY OF CLAIMANT´S COUNTRY OF RESIDENCE: Podnositelj zahtjeva je rezident .................................. prema članku ............... Ugovora o izbjegavanju dvostrukog oporezivanja između Republike Hrvatske i .................................... – The claimant is the resident of ................................... under Article .......... of the Agreement for the avoidance of double taxation between the Republic of Croatia and .................................... .................................................... ..................................................... .................................................... Mjesto i datum - Place and date Pečat - Stamp Potpis - Signature UPUTA ZA POPUNJAVANJE: LICENCE
61. Ovaj obrazac podnosi se radi umanjenja porezne obveze, izuzimanja od poreza ili povrata više plaćenog poreza za licence i slična davanja osobi koja ima prebivalište, uobičajeno boravište ili sjedište (rezidentu) u državi s kojom je Republika Hrvatska sklopila Ugovor o izbjegavanju dvostrukog oporezivanja.
62. Obrazac se sastoji od četiri primjerka. Prvi je primjerak za podnositelja zahtjeva, drugi za isplatitelja, treći za Poreznu upravu Ministarstva financija Republike Hrvatske, a četvrti za inozemno porezno tijelo. Točke II, IV, V i VI popunjava podnositelj zahtjeva, točke I i III popunjava isplatitelj, a točku VII popunjava inozemno porezno tijelo. Popunjeni i potpisani primjerci obrasca predaju se inozemnim poreznim tijelima zemlje koje je primatelj rezident. Inozemna porezna tijela će provesti potrebnu kontrolu, ovjeriti predočeni obrazac i zadržati svoj primjerak, a podnositelju zahtjeva vratiti preostala tri primjerka (za podnositelja zahtjeva, isplatitelja i Poreznu upravu Ministarstva financija Republike Hrvatske).
63. Za svakog isplatitelja i za svaku isplatu podnosi se poseban zahtjev.
64. Zahtjev za umanjenje porezne obveze, izuzimanje od poreza ili povrat više plaćenog poreza podnosi se Ministarstvu financija Republike Hrvatske, Poreznoj upravi, Područnom uredu Zagreb, Avenija Dubrovnik 32, najkasnije u roku od tri godine od isteka kalendarske godine u kojoj je isplata izvršena. INSTRUCTIONS FOR FILLING IN THE FORM: ROYALTIES
65. This form is submitted for tax relief, tax exemption or tax refund for royalties to a resident of the country with which the Republic of Croatia entered into Agreement for the Avoidance of Double Taxation.
66. The form consists of four copies. The first copy is for the claimant, the second for the payer of the income, the third copy for the Tax Administration of the Republic of Croatia, and the forth copy for the foreign tax authority. Items II, IV, V and VI are to be filled in by the claimant, items I and III by the payer of the income, and the item VII by the foreign tax authority. The filled in and signed copies of the form are submitted to the tax authorities of the country in which the recipient is resident. Foreign tax authorities shall carry out the required control, certify a submitted form, and retain their own copy, and return the three remaining copies to the claimant (for the claimant, payer of the income, and the Tax Administration of the Republic of Croatia).
67. For each payer and for each payment a separate claim is made.
68. Application for tax relief, tax exemption or tax refund is submitted to the Ministry of Finance of the Republic of Croatia, Tax Administration, Zagreb office, Avenija Dubrovnik 32, at latest within 3 years as of expiry of the calendar year in which the payment is effected. OBRAZAC– KAMATE FORM – INTEREST PRIMJERAK 1 - za podnositelja zahtjeva - COPY 1 - for the claimant - R E P U B L I K A H R V A T S K A MINISTARSTVO FINANCIJA – POREZNA UPRAVA THE REPUBLIC OF CROATIA MINISTRY OF FINANCE – TAX ADMINISTRATION ZAHTJEV ZA UMANJENJE POREZNE OBVEZE, IZUZIMANJE OD POREZA ILI POVRAT VIŠE PLAĆENOG POREZA NA KAMATE, PREMA UGOVORU O IZBJEGAVANJU DVOSTRUKOG OPOREZIVANJA IZMEĐU REPUBLIKE HRVATSKE I ……………………………… ("Narodne novine – Međunarodni ugovori", broj: ..…) APPLICATION FOR TAX RELIEF, TAX EXEMPTION OR TAX REFUND FOR INTEREST UNDER THE AGREEMENT FOR THE AVOIDANCE OF DOUBLE TAXATION BETWEEN THE REPUBLIC OF CROATIA AND ......................................... ("Official Gazette – International Agreements", number: ..…) Podaci iz ovog Zahtjeva potrebni su zbog primjene članka
69. Zakona o porezu na dohodak ("Narodne novine", broj 127/00.) i članka
70. Zakona o porezu na dobit ("Narodne novine", broj 127/00.) – The data to be given in this application are requested under Article 26 of Income Tax Act ("Official Gazette", number 127/00) and Article 22 of Profit Tax Act ("Official Gazette", number 127/00) I. PODACI O ISPLATITELJU KAMATE – INFORMATION ON THE PAYER OF THE INTEREST: Ime i prezime / naziv tvrtke – Full name / business name: .................................................................................................................... Pravni oblik – Legal form: ...................................................................................................................................................................... Broj (JMBG ili matični broj) - Number (identification number / tax number): .......................................................................................... Prebivalište / sjedište – Address: ........................................................................................................................................................... Ulica i broj – Street and number: .................................................................................................................................................... Poštanski broj – Postal code: ...................................................Grad – City: .................................................................................. Država – State: .............................................................................................................................................................................. II. PODACI O PODNOSITELJU ZAHTJEVA - primatelju kamate – INFORMATION ON THE CLAIMANT – recipient of the interest: Ime i prezime / naziv tvrtke – Full name / business name: .................................................................................................................... Pravni oblik – Legal form: ...................................................................................................................................................................... Broj – Number: ....................................................................................................................................................................................... Prebivalište / sjedište – Address: ........................................................................................................................................................... Ulica i broj – Street and number: .................................................................................................................................................... Poštanski broj – Postal code: ...................................................Grad – City: .................................................................................. Država – State: .............................................................................................................................................................................. Ime i prezime / naziv zastupnika (ako ga ima) – Name of the representative (if any): .......................................................................... Prebivalište / sjedište – Address: ........................................................................................................................................................... III. PODACI O DOHOTKU – DESCRIPTION OF THE INCOME: Temelj isplate – Payment basis: ............................................................................................................................................................ Datum izdavanja ili sklapanja ugovora – Date of issue or conclusion of the contract: .......................................................................... Ukupan iznos kamate – Total amount of interest: .................................................................................................................................. Datum isplate – Date of payment: .............................................................................................................................................. Ukupan iznos poreza – Total amount of tax: ................................................................................................................................... IV. PRILOŽENI DOKUMENTI (broj i naziv) – Documents attached (number and title):...................................................................... ............................................................................................................................................................................................................... V. NAČIN POVRATA VIŠE PLAĆENOG POREZA – procedure of the refund: U Republici Hrvatskoj ili u – In the Republic of Croatia or in: ................................................................................................................. Na broj računa – To the account number: ............................................................................................................................................ Kod (banka) – With the (bank): .............................................................................................................................................................. Otvorenog na ime – Opened in the name of: ......................................................................................................................................... VI. IZJAVA PODNOSITELJA ZAHTJEVA – STATEMENT OF THE CLAIMANT: Potpisnik jamči da su gore navedeni podaci istiniti te da podnositelj zahtjeva, naveden pod točkom II., ispunjava slijedeće uvjete – The undersigned certifies that the beneficial owner mentioned under II fulfills the following conditions:
71. Stvarni je korisnik gore navedenog dohotka – He is the beneficial owner of the mentioned income,
72. Dohodak u smislu navedenog Ugovora o izbjegavanju dvostrukog oporezivanja nije ostvaren kroz djelatnost registriranu u Republici Hrvatskoj – He did not derive income, as defined in the mentioned Agreement for the avoidance of double taxation, through the activity registered in the Republic of Croatia, Poznato mi je da Porezna uprava Republike Hrvatske može poreznom tijelu u državi rezidentnosti podnositelja zahtjeva davati podatke o sadržaju ovog zahtjeva – I am aware of the fact that the Croatian Tax Administration can disclose the information given in this Application to the tax authorities in the country of residence of the claimant. .................................................... .......................................... Mjesto i datum – Place and date Potpis - Signature VII. POTVRDA POREZNOG TIJELA DRŽAVE REZIDENTNOSTI PODNOSITELJA ZAHTJEVA – CERTIFICATE OF TAX AUTHORITY OF CLAIMANT´S COUNTRY OF RESIDENCE: Podnositelj zahtjeva je rezident .................................. prema članku ............... Ugovora o izbjegavanju dvostrukog oporezivanja između Republike Hrvatske i .................................... – The claimant is the resident of ................................... under Article .......... of the Agreement for the avoidance of double taxation between the Republic of Croatia and .................................... .................................................... ..................................................... .................................................... Mjesto i datum - Place and date Pečat - Stamp Potpis - Signature PRIMJERAK 2 - za isplatitelja dohotka - COPY 2 - for the payer of the income - R E P U B L I K A H R V A T S K A MINISTARSTVO FINANCIJA – POREZNA UPRAVA THE REPUBLIC OF CROATIA MINISTRY OF FINANCE – TAX ADMINISTRATION ZAHTJEV ZA UMANJENJE POREZNE OBVEZE, IZUZIMANJE OD POREZA ILI POVRAT VIŠE PLAĆENOG POREZA NA KAMATE, PREMA UGOVORU O IZBJEGAVANJU DVOSTRUKOG OPOREZIVANJA IZMEĐU REPUBLIKE HRVATSKE I ……………………………… ("Narodne novine – Međunarodni ugovori", broj: ..…) APPLICATION FOR TAX RELIEF, TAX EXEMPTION OR TAX REFUND FOR INTEREST UNDER THE AGREEMENT FOR THE AVOIDANCE OF DOUBLE TAXATION BETWEEN THE REPUBLIC OF CROATIA AND ......................................... ("Official Gazette – International Agreements", number: ..…) Podaci iz ovog Zahtjeva potrebni su zbog primjene članka
73. Zakona o porezu na dohodak ("Narodne novine", broj 127/00.) i članka
74. Zakona o porezu na dobit ("Narodne novine", broj 127/00.) – The data to be given in this application are requested under Article 26 of Income Tax Act ("Official Gazette", number 127/00) and Article 22 of Profit Tax Act ("Official Gazette", number 127/00) I. PODACI O ISPLATITELJU KAMATE – INFORMATION ON THE PAYER OF THE INTEREST: Ime i prezime / naziv tvrtke – Full name / business name: .................................................................................................................... Pravni oblik – Legal form: ...................................................................................................................................................................... Broj (JMBG ili matični broj) - Number (identification number / tax number): .......................................................................................... Prebivalište / sjedište – Address: ........................................................................................................................................................... Ulica i broj – Street and number: .................................................................................................................................................... Poštanski broj – Postal code: ...................................................Grad – City: .................................................................................. Država – State: .............................................................................................................................................................................. II. PODACI O PODNOSITELJU ZAHTJEVA - primatelju kamate – INFORMATION ON THE CLAIMANT – recipient of the interest: Ime i prezime / naziv tvrtke – Full name / business name: .................................................................................................................... Pravni oblik – Legal form: ...................................................................................................................................................................... Broj – Number: ....................................................................................................................................................................................... Prebivalište / sjedište – Address: ........................................................................................................................................................... Ulica i broj – Street and number: .................................................................................................................................................... Poštanski broj – Postal code: ...................................................Grad – City: .................................................................................. Država – State: .............................................................................................................................................................................. Ime i prezime / naziv zastupnika (ako ga ima) – Name of the representative (if any): .......................................................................... Prebivalište / sjedište – Address: ........................................................................................................................................................... III. PODACI O DOHOTKU – DESCRIPTION OF THE INCOME: Temelj isplate – Payment basis: ............................................................................................................................................................ Datum izdavanja ili sklapanja ugovora – Date of issue or conclusion of the contract: .......................................................................... Ukupan iznos kamate – Total amount of interest: .................................................................................................................................. Datum isplate – Date of payment: .............................................................................................................................................. Ukupan iznos poreza – Total amount of tax: ................................................................................................................................... IV. PRILOŽENI DOKUMENTI (broj i naziv) – Documents attached (number and title):...................................................................... ............................................................................................................................................................................................................... V. NAČIN POVRATA VIŠE PLAĆENOG POREZA – procedure of the refund: U Republici Hrvatskoj ili u – In the Republic of Croatia or in: ................................................................................................................. Na broj računa – To the account number: ............................................................................................................................................ Kod (banka) – With the (bank): .............................................................................................................................................................. Otvorenog na ime – Opened in the name of: ......................................................................................................................................... VI. IZJAVA PODNOSITELJA ZAHTJEVA – STATEMENT OF THE CLAIMANT: Potpisnik jamči da su gore navedeni podaci istiniti te da podnositelj zahtjeva, naveden pod točkom II., ispunjava slijedeće uvjete – The undersigned certifies that the beneficial owner mentioned under II fulfills the following conditions:
75. Stvarni je korisnik gore navedenog dohotka – He is the beneficial owner of the mentioned income,
76. Dohodak u smislu navedenog Ugovora o izbjegavanju dvostrukog oporezivanja nije ostvaren kroz djelatnost registriranu u Republici Hrvatskoj – He did not derive income, as defined in the mentioned Agreement for the avoidance of double taxation, through the activity registered in the Republic of Croatia, Poznato mi je da Porezna uprava Republike Hrvatske može poreznom tijelu u državi rezidentnosti podnositelja zahtjeva davati podatke o sadržaju ovog zahtjeva – I am aware of the fact that the Croatian Tax Administration can disclose the information given in this Application to the tax authorities in the country of residence of the claimant. .................................................... .......................................... Mjesto i datum – Place and date Potpis - Signature VII. POTVRDA POREZNOG TIJELA DRŽAVE REZIDENTNOSTI PODNOSITELJA ZAHTJEVA – CERTIFICATE OF TAX AUTHORITY OF CLAIMANT´S COUNTRY OF RESIDENCE: Podnositelj zahtjeva je rezident .................................. prema članku ............... Ugovora o izbjegavanju dvostrukog oporezivanja između Republike Hrvatske i .................................... – The claimant is the resident of ................................... under Article .......... of the Agreement for the avoidance of double taxation between the Republic of Croatia and .................................... .................................................... ..................................................... .................................................... Mjesto i datum - Place and date Pečat - Stamp Potpis - Signature PRIMJERAK 3 - za Poreznu upravu Republike Hrvatske - COPY 3 - for the Tax Administration of the Republic of Croatia - R E P U B L I K A H R V A T S K A MINISTARSTVO FINANCIJA – POREZNA UPRAVA THE REPUBLIC OF CROATIA MINISTRY OF FINANCE – TAX ADMINISTRATION ZAHTJEV ZA UMANJENJE POREZNE OBVEZE, IZUZIMANJE OD POREZA ILI POVRAT VIŠE PLAĆENOG POREZA NA KAMATE, PREMA UGOVORU O IZBJEGAVANJU DVOSTRUKOG OPOREZIVANJA IZMEĐU REPUBLIKE HRVATSKE I ……………………………… ("Narodne novine – Međunarodni ugovori", broj: ..…) APPLICATION FOR TAX RELIEF, TAX EXEMPTION OR TAX REFUND FOR INTEREST UNDER THE AGREEMENT FOR THE AVOIDANCE OF DOUBLE TAXATION BETWEEN THE REPUBLIC OF CROATIA AND ......................................... ("Official Gazette – International Agreements", number: ..…) Podaci iz ovog Zahtjeva potrebni su zbog primjene članka
77. Zakona o porezu na dohodak ("Narodne novine", broj 127/00.) i članka
78. Zakona o porezu na dobit ("Narodne novine", broj 127/00.) – The data to be given in this application are requested under Article 26 of Income Tax Act ("Official Gazette", number 127/00) and Article 22 of Profit Tax Act ("Official Gazette", number 127/00) I. PODACI O ISPLATITELJU KAMATE – INFORMATION ON THE PAYER OF THE INTEREST: Ime i prezime / naziv tvrtke – Full name / business name: .................................................................................................................... Pravni oblik – Legal form: ...................................................................................................................................................................... Broj (JMBG ili matični broj) - Number (identification number / tax number): .......................................................................................... Prebivalište / sjedište – Address: ........................................................................................................................................................... Ulica i broj – Street and number: .................................................................................................................................................... Poštanski broj – Postal code: ...................................................Grad – City: .................................................................................. Država – State: .............................................................................................................................................................................. II. PODACI O PODNOSITELJU ZAHTJEVA - primatelju kamate – INFORMATION ON THE CLAIMANT – recipient of the interest: Ime i prezime / naziv tvrtke – Full name / business name: .................................................................................................................... Pravni oblik – Legal form: ...................................................................................................................................................................... Broj – Number: ....................................................................................................................................................................................... Prebivalište / sjedište – Address: ........................................................................................................................................................... Ulica i broj – Street and number: .................................................................................................................................................... Poštanski broj – Postal code: ...................................................Grad – City: .................................................................................. Država – State: .............................................................................................................................................................................. Ime i prezime / naziv zastupnika (ako ga ima) – Name of the representative (if any): .......................................................................... Prebivalište / sjedište – Address: ........................................................................................................................................................... III. PODACI O DOHOTKU – DESCRIPTION OF THE INCOME: Temelj isplate – Payment basis: ............................................................................................................................................................ Datum izdavanja ili sklapanja ugovora – Date of issue or conclusion of the contract: .......................................................................... Ukupan iznos kamate – Total amount of interest: .................................................................................................................................. Datum isplate – Date of payment: .......................................................................................................................................................... Ukupan iznos poreza – Total amount of tax: ........................................................................................................................................ IV. PRILOŽENI DOKUMENTI (broj i naziv) – Documents attached (number and title):...................................................................... ............................................................................................................................................................................................................... V. NAČIN POVRATA VIŠE PLAĆENOG POREZA – procedure of the refund: U Republici Hrvatskoj ili u – In the Republic of Croatia or in: ................................................................................................................. Na broj računa – To the account number: ........................................................................................................................................... Kod (banka) – With the (bank): .............................................................................................................................................................. Otvorenog na ime – Opened in the name of: ......................................................................................................................................... VI. IZJAVA PODNOSITELJA ZAHTJEVA – STATEMENT OF THE CLAIMANT: Potpisnik jamči da su gore navedeni podaci istiniti te da podnositelj zahtjeva, naveden pod točkom II., ispunjava slijedeće uvjete – The undersigned certifies that the beneficial owner mentioned under II fulfills the following conditions:
79. Stvarni je korisnik gore navedenog dohotka – He is the beneficial owner of the mentioned income,
80. Dohodak u smislu navedenog Ugovora o izbjegavanju dvostrukog oporezivanja nije ostvaren kroz djelatnost registriranu u Republici Hrvatskoj – He did not derive income, as defined in the mentioned Agreement for the avoidance of double taxation, through the activity registered in the Republic of Croatia, Poznato mi je da Porezna uprava Republike Hrvatske može poreznom tijelu u državi rezidentnosti podnositelja zahtjeva davati podatke o sadržaju ovog zahtjeva – I am aware of the fact that the Croatian Tax Administration can disclose the information given in this Application to the tax authorities in the country of residence of the claimant. .................................................... .......................................... Mjesto i datum – Place and date Potpis - Signature VII. POTVRDA POREZNOG TIJELA DRŽAVE REZIDENTNOSTI PODNOSITELJA ZAHTJEVA – CERTIFICATE OF TAX AUTHORITY OF CLAIMANT´S COUNTRY OF RESIDENCE: Podnositelj zahtjeva je rezident .................................. prema članku ............... Ugovora o izbjegavanju dvostrukog oporezivanja između Republike Hrvatske i .................................... – The claimant is the resident of ................................... under Article .......... of the Agreement for the avoidance of double taxation between the Republic of Croatia and .................................... .................................................... ..................................................... .................................................... Mjesto i datum - Place and date Pečat - Stamp Potpis - Signature VIII. NAPOMENE POREZNE UPRAVE REPUBLIKE HRVATSKE (ako ih ima)- CROATIAN TAX AUTHORITIES REMARKS (if any) PRIMJERAK 4 - za inozemno porezno tijelo - COPY 4 - for the foreign tax authotity - R E P U B L I K A H R V A T S K A MINISTARSTVO FINANCIJA – POREZNA UPRAVA THE REPUBLIC OF CROATIA MINISTRY OF FINANCE – TAX ADMINISTRATION ZAHTJEV ZA UMANJENJE POREZNE OBVEZE, IZUZIMANJE OD POREZA ILI POVRAT VIŠE PLAĆENOG POREZA NA KAMATE, PREMA UGOVORU O IZBJEGAVANJU DVOSTRUKOG OPOREZIVANJA IZMEĐU REPUBLIKE HRVATSKE I ……………………………… ("Narodne novine – Međunarodni ugovori", broj: ..…) APPLICATION FOR TAX RELIEF, TAX EXEMPTION OR TAX REFUND FOR INTEREST UNDER THE AGREEMENT FOR THE AVOIDANCE OF DOUBLE TAXATION BETWEEN THE REPUBLIC OF CROATIA AND ......................................... ("Official Gazette – International Agreements", number: ..…) Podaci iz ovog Zahtjeva potrebni su zbog primjene članka
81. Zakona o porezu na dohodak ("Narodne novine", broj 127/00.) i članka
82. Zakona o porezu na dobit ("Narodne novine", broj 127/00.) – The data to be given in this application are requested under Article 26 of Income Tax Act ("Official Gazette", number 127/00) and Article 22 of Profit Tax Act ("Official Gazette", number 127/00) I. PODACI O ISPLATITELJU KAMATE – INFORMATION ON THE PAYER OF THE INTEREST: Ime i prezime / naziv tvrtke – Full name / business name: .................................................................................................................... Pravni oblik – Legal form: ...................................................................................................................................................................... Broj (JMBG ili matični broj) - Number (identification number / tax number): .......................................................................................... Prebivalište / sjedište – Address: ........................................................................................................................................................... Ulica i broj – Street and number: .................................................................................................................................................... Poštanski broj – Postal code: ...................................................Grad – City: .................................................................................. Država – State: .............................................................................................................................................................................. II. PODACI O PODNOSITELJU ZAHTJEVA - primatelju kamate – INFORMATION ON THE CLAIMANT – recipient of the interest: Ime i prezime / naziv tvrtke – Full name / business name: .................................................................................................................... Pravni oblik – Legal form: ...................................................................................................................................................................... Broj – Number: ....................................................................................................................................................................................... Prebivalište / sjedište – Address: ........................................................................................................................................................... Ulica i broj – Street and number: .................................................................................................................................................... Poštanski broj – Postal code: ...................................................Grad – City: .................................................................................. Država – State: .............................................................................................................................................................................. Ime i prezime / naziv zastupnika (ako ga ima) – Name of the representative (if any): .......................................................................... Prebivalište / sjedište – Address: ........................................................................................................................................................... III. PODACI O DOHOTKU – DESCRIPTION OF THE INCOME: Temelj isplate – Payment basis: ............................................................................................................................................................ Datum izdavanja ili sklapanja ugovora – Date of issue or conclusion of the contract: .......................................................................... Ukupan iznos kamate – Total amount of interest: .................................................................................................................................. Datum isplate – Date of payment: .............................................................................................................................................. Ukupan iznos poreza – Total amount of tax: ................................................................................................................................... IV. PRILOŽENI DOKUMENTI (broj i naziv) – Documents attached (number and title):...................................................................... ............................................................................................................................................................................................................... V. NAČIN POVRATA VIŠE PLAĆENOG POREZA – procedure of the refund: U Republici Hrvatskoj ili u – In the Republic of Croatia or in: ................................................................................................................. Na broj računa – To the account number: ............................................................................................................................................ Kod (banka) – With the (bank): .............................................................................................................................................................. Otvorenog na ime – Opened in the name of: ......................................................................................................................................... VI. IZJAVA PODNOSITELJA ZAHTJEVA – STATEMENT OF THE CLAIMANT: Potpisnik jamči da su gore navedeni podaci istiniti te da podnositelj zahtjeva, naveden pod točkom II., ispunjava slijedeće uvjete – The undersigned certifies that the beneficial owner mentioned under II fulfills the following conditions:
83. Stvarni je korisnik gore navedenog dohotka – He is the beneficial owner of the mentioned income,
84. Dohodak u smislu navedenog Ugovora o izbjegavanju dvostrukog oporezivanja nije ostvaren kroz djelatnost registriranu u Republici Hrvatskoj – He did not derive income, as defined in the mentioned Agreement for the avoidance of double taxation, through the activity registered in the Republic of Croatia, Poznato mi je da Porezna uprava Republike Hrvatske može poreznom tijelu u državi rezidentnosti podnositelja zahtjeva davati podatke o sadržaju ovog zahtjeva – I am aware of the fact that the Croatian Tax Administration can disclose the information given in this Application to the tax authorities in the country of residence of the claimant. .................................................... .......................................... Mjesto i datum – Place and date Potpis - Signature VII. POTVRDA POREZNOG TIJELA DRŽAVE REZIDENTNOSTI PODNOSITELJA ZAHTJEVA – CERTIFICATE OF TAX AUTHORITY OF CLAIMANT´S COUNTRY OF RESIDENCE: Podnositelj zahtjeva je rezident .................................. prema članku ............... Ugovora o izbjegavanju dvostrukog oporezivanja između Republike Hrvatske i .................................... – The claimant is the resident of ................................... under Article .......... of the Agreement for the avoidance of double taxation between the Republic of Croatia and .................................... .................................................... ..................................................... .................................................... Mjesto i datum - Place and date Pečat - Stamp Potpis - Signature UPUTA ZA POPUNJAVANJE: KAMATE
85. Ovaj obrazac podnosi se radi umanjenja porezne obveze, izuzimanja od poreza ili povrata više plaćenog poreza na kamate osobi koja ima prebivalište, uobičajeno boravište ili sjedište (rezidentu) u državi s kojom je Republika Hrvatska sklopila Ugovor o izbjegavanju dvostrukog oporezivanja.
86. Obrazac se sastoji od četiri primjerka. Prvi je primjerak za podnositelja zahtjeva, drugi za isplatitelja, treći za Poreznu upravu Ministarstva financija Republike Hrvatske, a četvrti za inozemno porezno tijelo. Točke II, IV, V i VI popunjava podnositelj zahtjeva, točke I i III popunjava isplatitelj, a točku VII popunjava inozemno porezno tijelo. Popunjeni i potpisani primjerci obrasca predaju se inozemnim poreznim tijelima zemlje koje je primatelj rezident. Inozemna porezna tijela će provesti potrebnu kontrolu, ovjeriti predočeni obrazac i zadržati svoj primjerak, a podnositelju zahtjeva vratiti preostala tri primjerka (za podnositelja zahtjeva, isplatitelja i Poreznu upravu Ministarstva financija Republike Hrvatske).
87. Za svakog isplatitelja i za svaku isplatu podnosi se poseban zahtjev.
88. Zahtjev za umanjenje porezne obveze, izuzimanje od poreza ili povrat više plaćenog poreza podnosi se Ministarstvu financija Republike Hrvatske, Poreznoj upravi, Područnom uredu Zagreb, Avenija Dubrovnik 32, najkasnije u roku od tri godine od isteka kalendarske godine u kojoj je isplata izvršena. INSTRUCTIONS FOR FILLING IN THE FORM: INTERESTS This form is submitted for tax relief, tax exemption or tax refund for interest to a resident of the country with which the Republic of Croatia entered into Agreement for the Avoidance of Double Taxation. The form consists of four copies. The first copy is for the claimant, the second for the payer of the income, the third copy for the Tax Administration of the Republic of Croatia, and the forth copy for the foreign tax authority. Items II, IV, V, and VI are to be filled in by the claimant, items I and III by the payer of the income, and the item VII by the foreign tax authority. The filled in and signed copies of the form are submitted to the tax authorities of the country in which the recipient is resident. Foreign tax authorities shall carry out the required control, certify a submitted form, and retain their own copy, and return the three remaining copies to the claimant (for the claimant, payer of the income, and the Tax Administration of the Republic of Croatia). For each payer and for each payment a separate claim is made.
89. Application for tax relief, tax exemption or tax refund is submitted to the Ministry of finance of the Republic of Croatia, Tax administration, Zagreb office, Avenija Dubrovnik 32, at latest within 3 years as of expiry of the calendar year in which the payment is effected. Ostalo, NN 1/2001-30 Više Dio NN: Službeni Vrsta dokumenta: Ostalo Izdanje: NN 1/2001 Broj dokumenta u izdanju: 30 Donositelj:Glavna urednica Datum tiskanog izdanja: 5.1.
90. ELI: /eli/sluzbeni/2001/1/30 Opći uvjeti korištenjaZaštita privatnostiPristup podatcimaELI©
91. g. Narodne novine d.d. , izrada Novena d.o.o. Opći uvjeti korištenja Odgovornost za objavljene sadržaje Narodne novine d.d. će poduzeti razumne i odgovarajuće napore kako bi informacije na ovim internetskim stranicama bile potpune i točne, ali ne odgovara u slučaju njihove netočnosti ili nepotpunosti. Narodne novine d.d. ne odgovaraju za štetu ili povredu koja može biti rezultat korištenja ili nemogućnosti korištenja bilo kojeg dijela ove web-lokacije ili nečeg što je na njoj objavljeno. Ove internetske stranice sadrže i informacije trećih osoba i poveznice na druge internetske sadržaje. Narodne novine d.d. ne odgovaraju za sadržaje na vanjskim izvorima podataka do kojih mogu voditi poveznice s naših internetskih stranica, niti odgovara, niti upućuje na način i uvjete korištenja tih sadržaja. Narodne novine d.d. ne odgovaraju za sadržaje koje na ove internetske stranice stave treće osobe. Zaštita autorskog prava Svi sadržaji objavljeni na ovim internetskim stranicama zaštićeni su autorskim pravom i mogu se koristiti samo pod uvjetima propisanim Zakonom. Promjene Narodne novine d.d. zadržavaju pravo izmjene, dopune ili uklanjanja bilo kojeg dijela ovih internetskih stranica u bilo kojem trenutku. Promjene stupaju na snagu objavljivanjem na ovim internetskim stranicama ili kada su korisnici o njima obaviješteni. Zaštita privatnosti Narodne novine d.d se obvezuju poštivati anonimnost i privatnost korisnika ovih internetskih stranica. O posjetiteljima se neće prikupljati nikakvi osobni podaci osim u slučajevima ako ih posjetitelj dobrovoljno dostavi Narodnim novinama d.d. U slučajevima kad je poznat indentitet posjetitelja/pošiljatelja, njegovi će se podaci koristiti samo u svrhu zbog koje ih je pošiljatelj poslao. Narodne novine d.d. takve podatke mogu koristiti i za što bolji uvid i razumijevanja pojedinačnih potreba i zahtjeva korisnika kao i razvijanja mogućnosti što kvalitetnijega pružanja svojih usluga korisnicima. Narodne novine d.d. se obvezuju da navedene podatke neće učiniti dostupnim bilo kojoj trećoj osobi odnosno strani bez izričitoga pristanka korisnika. Narodne novine d.d. upozoravaju posjetitelje/korisnike na ograničenja suvremenih informacijsko-komunikacijskih tehnologija u odnosu na sigurnost i zaštitu privatnosti osobnih podataka.