Form 5000 En PDF Details

In an increasingly interconnected world, understanding international tax procedures is indispensable for individuals and entities engaging in cross-border transactions. The 5000-EN form embodies a crucial mechanism for this understanding, serving as a Certificate of Residence that facilitates the application of tax treaties between France and other countries. This form is utilized by beneficiaries, such as individuals or companies, to assert their entitlement to treaty benefits on income such as dividends, interest, and royalties, ensuring that taxation aligns with the provisions of the relevant tax treaty. It encapsulates various declarations and attachments necessary for the application, including the beneficiary's assertion of residency and entitlement, as well as declarations from both the paying institution and the relevant foreign tax authority. For United States residents, a specific declaration by a US financial institution is required, underlining the form's comprehensive approach to validating the beneficiary's claims. Investment companies and funds are also provided for, with sections addressing their particular circumstances. In essence, the form serves as a pivotal document in the complex realm of international taxation, streamlining the process of claiming tax treaty benefits and reinforcing the principles of transparency and due process within this global context.

QuestionAnswer
Form NameForm 5000 En
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namesform 5000 france, tax certificate residence, en certificate residence, tax certificate residence online

Form Preview Example

For use by the

foreign tax

authority

5000-EN

CERTIFICATE OF RESIDENCE

12816*01

Application for implementation of the tax treaty between France and

NUMBER OF

ATTACHMENTS

Please write the name of the country in this box

I) Types of income

Dividends

Normal procedure

Attach Form 5001

 

Interest

Attach Form 5002

Simplified procedure

File this certificate

of

Royalties

Attach Form 5003

 

 

 

residence only

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

II) Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Surname and first name, or

....................................................................................................................................................

 

 

 

 

company name

 

....................................................................................................................................................

 

 

Occupation

 

....................................................................................................................................................

 

 

Full home address

 

....................................................................................................................................................

 

 

or registered office

 

....................................................................................................................................................

 

 

 

 

 

 

 

 

 

For United States residents

....................................................................……

See note

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

III) Beneficiary’s declaration

Investment companies and funds please complete box VII as well

I hereby declare that:

 

 

- I am beneficially entitled to the income for which the treaty benefits are being claimed;

 

- For the purposes of the abovementioned tax treaty, the beneficiary is a resident of (or in the case of pension fund

or

an investment company , is established in) …………………...……………………………………………………….

;

- I do not have any establishment or permanent base that this income is attached to in France;

 

- This income has been or will be reported to the tax authorities in my country of residence.

 

………………………………………………...

 

 

Date and place

Signature of beneficiary or his/her legal representative

 

IV) Declaration of the foreign tax authority

The tax authority of ……………………………………..………………… hereby certifies that to the best of its knowledge:

- The information provided by the applicant is correct;

 

- For the purposes of the abovementioned tax treaty, the beneficiary is a resident of (or in the case of pension fund

or

an investment company , is established in) …………………...……………………………………………………….

;

-The beneficiary of the income is subject to taxation by the authority under the tax identification number …………….…..

(where applicable).

………………………………………………...

Date and place

Signature and seal

V) Declaration of the paying institution

Name

Address

SIREN number

...........................................................................................................................................................................

...........................................................................................................................................................................

...........................................................................................................................................................................

...........................................................................................................................................................................

We hereby declare that we have paid the beneficiary the income referred to in this application, net of the withholding tax at the rate provided for in French domestic law.

………………………………………………...

Date and place

Seal

VI) Declaration of the US financial institution

(For beneficiaries who are United States residents only)

Name

Address

...........................................................................................................................................................................

...........................................................................................................................................................................

...........................................................................................................................................................................

The abovenamed institution hereby certifies that, to the best of its knowledge, the applicant is a resident of the United States and that the information provided on this form is correct.

………………………………………………...

Date and placeSeal

VII) Investment company or fund

 

 

 

 

 

 

- Financial year from………...………… to…………………;

- Number of unit holders or shareholders in fund:

 

- In the case of German funds, if the French authorities

...................................…………………………

have issued an authorisation: authorisation date and number:

- Percentage of unit holders or shareholders who are

 

 

 

authorisation number ……………… date ………………..……..

residents of:

:

%

 

 

 

 

VIII) In case of direct refund by the tax authority

Where should the repayment be sent (bank, post office, account) ?

..................................................................................................................................................................................................................

..................................................................................................................................................................................................................

..................................................................................................................................................................................................................

To be kept by the beneficiary

5000-EN

CERTIFICATE OF RESIDENCE

12816*01

Application for implementation of the tax treaty between France and

NUMBER OF

ATTACHMENTS

Please write the name of the country in this box

I) Types of income

Dividends

Normal procedure

Attach Form 5001

 

Interest

Attach Form 5002

Simplified procedure

File this certificate

of

Royalties

Attach Form 5003

 

 

 

residence only

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

II) Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Surname and first name, or

....................................................................................................................................................

 

 

 

 

company name

 

....................................................................................................................................................

 

 

Occupation

 

....................................................................................................................................................

 

 

Full home address

 

....................................................................................................................................................

 

 

or registered office

 

....................................................................................................................................................

 

 

 

 

 

 

 

 

 

For United States residents

....................................................................……

See note

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

III) Beneficiary’s declaration

Investment companies and funds please complete box VII as well

I hereby declare that:

 

 

- I am beneficially entitled to the income for which the treaty benefits are being claimed;

 

- For the purposes of the abovementioned tax treaty, the beneficiary is a resident of (or in the case of pension fund

or

an investment company , is established in) ……………………………………………………………………………

;

- I do not have any establishment or permanent base that this income is attached to in France;

 

- This income has been or will be reported to the tax authorities in my country of residence.

 

………………………………………………...

 

 

Date and place

Signature of beneficiary or his/her legal representative

 

IV) Declaration of the foreign tax authority

The tax authority of ……………………………………..………………… hereby certifies that to the best of its knowledge:

- The information provided by the applicant is correct;

 

- For the purposes of the abovementioned tax treaty, the beneficiary is a resident of (or in the case of pension fund

or

an investment company , is established in) …………………...……………………………………………………….

;

-The beneficiary of the income is subject to taxation by the authority under the tax identification number …………….…..

(where applicable).

………………………………………………...

Date and place

Signature and seal

V) Declaration of the paying institution

Name

Address

SIREN number

...........................................................................................................................................................................

...........................................................................................................................................................................

...........................................................................................................................................................................

...........................................................................................................................................................................

We hereby declare that we have paid the beneficiary the income referred to in this application, net of the withholding tax at the rate provided for in French domestic law.

………………………………………………...

Date and place

Seal

VI) Declaration of the US financial institution

(For beneficiaries who are United States residents only)

Name

Address

...........................................................................................................................................................................

...........................................................................................................................................................................

...........................................................................................................................................................................

The abovenamed institution hereby certifies that, to the best of its knowledge, the applicant is a resident of the United States and that the information provided on this form is correct.

………………………………………………...

Date and placeSeal

VII) Investment company or fund

 

 

 

 

 

 

- Financial year from………...………… to…………………;

- Number of unit holders or shareholders in fund:

 

- In the case of German funds, if the French authorities

...................................…………………………

have issued an authorisation: authorisation date and number:

- Percentage of unit holders or shareholders who are

 

 

 

authorisation number ……………… date ………………..……..

residents of:

:

%

 

 

 

 

VIII) In case of direct refund by the tax authority

Where should the repayment be sent (bank, post office, account) ?

..................................................................................................................................................................................................................

..................................................................................................................................................................................................................

..................................................................................................................................................................................................................

For use by the

French tax

authority

5000-EN

ATTESTATION DE RESIDENCE

12816*01

Demande d’application de la convention fiscale entre la France et

NOMBRE D’ANNEXES

Inscrire dans cette case le nom de l’Etat contractant

I) Nature des revenus

Dividendes

 

Procédure normale

Joindre

un formulaire

Intérêts

Joindre un formulaire

 

annexe n° 5001

Redevances

annexe n° 5002

Procédure simplifiée

File this

certificate of

Joindre un formulaire

residence only

annexe n° 5003

 

 

II) Désignation du bénéficiaire des revenus

Nom et prénom ou raison sociale

....................................................................................................................................................

 

....................................................................................................................................................

Profession

....................................................................................................................................................

Adresse complète du domicile

....................................................................................................................................................

ou du siège social

....................................................................................................................................................

Pour les résidents des Etats-Unis

....................................................................……

cf. notice

 

 

 

III) Déclaration du bénéficiaire des revenus

Fonds et sociétés d’investissement : compléter aussi le cadre VII

 

 

 

 

Le soussigné certifie :

 

 

-

être le bénéficiaire effectif des revenus pour lesquels le bénéfice de la convention est demandé ;

 

-

avoir, au sens de la convention fiscale susvisée, la qualité de résident de (ou s’agissant d’un fonds de pension ou d’un

 

fonds ou d’ une société d’investissement être établi à) …………………………………………...…………………..

;

- ne pas posséder en France d’établissement ou de base fixe auxquels se rattachent les revenus ;

 

- que ces revenus ont été ou seront déclarés à l’administration des impôts de l’Etat de résidence.

 

………………………………………………...

 

 

 

Date et lieu

Signature du bénéficiaire ou de son représentant légal

 

 

 

 

 

IV) Déclaration de l’administration étrangère

L’administration fiscale de ……………………………………………………..……………. certifie qu’à sa connaissance :

-les indications portées par le déclarant sur la présente demande sont exactes ;

-au sens de la convention fiscale susvisée le bénéficiaire a bien la qualité de résident de (ou s’agissant d’un fonds de

pension ou d’un fonds ou d’une société d’investissement être établi à) …………………………...……...……. ;

-le bénéficiaire des revenus relève de son ressort sous le numéro fiscal …………………...…………………………….…..

(si un tel numéro existe).

………………………………………………...

Date et lieu

Signature et tampon

V) Déclaration de l’établissement payeur

Nom / Dénomination

Adresse

Numéro SIREN

...........................................................................................................................................................................

...........................................................................................................................................................................

...........................................................................................................................................................................

...........................................................................................................................................................................

Nous certifions avoir payé au bénéficiaire les revenus compris dans la présente demande pour leur montant net c’est à dire déduction faite de l’impôt à la source au taux prévu par le droit interne français.

………………………………………………...

Date et lieu

Cachet

VI) Déclaration de l’établissement financier américain

(pour les seuls bénéficiaires résidents des Etats-Unis)

Nom / Dénomination

Adresse

...........................................................................................................................................................................

...........................................................................................................................................................................

...........................................................................................................................................................................

L’établissement désigné ci-avant certifie qu’à sa connaissance le déclarant est un résident des Etats-Unis et que les mentions portées sur cette déclaration sont exactes.

………………………………………………...

Date et lieuCachet

VII) Société ou fonds d’investissement

 

 

 

 

 

- Exercice social du ………...………… au …………………;

- Nombre de porteurs de parts du fonds :

 

 

 

- Pour les OPCVM d’Allemagne, si l’administration française

.........................................…………………………

 

 

a délivré une autorisation : date et numéro de l’autorisation :

- Pourcentage de porteurs de parts résidents de

 

 

 

autorisation n° …………………….. du ………………………

....................................................... :

%

 

 

 

VIII) En cas de remboursement direct par l’administration au créancier

Où le montant à rembourser doit-il être envoyé pour le compte du créancier (banque, compte chèque postal) ?

..................................................................................................................................................................................................................

..................................................................................................................................................................................................................

..................................................................................................................................................................................................................