ORDER OF THE GOVERNMENT OF THE REPUBLIC OF MOLDOVA

of January 19, 2010 No. 9

About approval of the standard forms confirming residence and payment by nonresidents of the income tax in the Republic of Moldova

In pursuance of part provisions (5) Art. 79-3 and Item i) Art. 136 of the Tax code No. 1163-XIII of April 24, 1997 (repeated publication: The official monitor of the Republic of Moldova, 2007, special release) DECIDES: the Government

Approve:

Standard form - Form 1-DTA-09 "The certificate on residence according to the Convention (Agreement) on avoidance of double taxation" according to appendix No. 1;

Standard form - Form 2-DTA-09 "The statement for issue of the certificate on confirmation of the income tax paid in the Republic of Moldova according to the Convention (Agreement) on avoidance of double taxation" according to appendix No. 2;

Standard form - Form 3-DTA-09 "The statement for issue of the certificate on confirmation of the income tax paid in the Republic of Moldova in the absence of the international treaty" according to appendix No. 3;

Standard form - Form 4-DTA-09 "The certificate on confirmation of the income tax paid in the Republic of Moldova according to the Convention (Agreement) on avoidance of double taxation" according to appendix No. 4;

Standard form - Form 5-DTA-09 "The certificate on confirmation of the income tax paid in the Republic of Moldova in the absence of the international treaty" according to appendix No. 5;

Standard form - Form 6-DTA-09 "The certificate on confirmation of the income tax paid in the Republic of Moldova according to the Convention (Agreement) on avoidance of double taxation by foreign physical persons overlooking residence in the Republic of Moldova" according to appendix No. 6;

Standard form - Form 7-DTA-09 "The certificate on confirmation of the income tax paid in the Republic of Moldova according to the current legislation by foreign physical persons overlooking residence in the Republic of Moldova" according to appendix No. 7;

Standard form - Form 8-DTA-09 "The statement for compensation of the income tax withheld from the sources which are in the Republic of Moldova" according to appendix No. 8;

The instruction for filling of the standard forms confirming residence and payment by nonresidents of the income tax in the Republic of Moldova according to appendix No. 9.

Appendix №1

to the Order of the Government of January 19, 2010 No. 9

Standard form - Form 1-DTA-09 "Certificate on residence according to the Convention (Agreement) on avoidance of double taxation"

 
             _________________nr./ № ____________________
               La nr. _________________________________
                                 На № 

                       CERTIFICAT DE REZIDENTA 
    IN CONFORMITATE CU CONVENTIA (ACORDUL) PENTRU EVITAREA DUBLEI
                 IMPUNERI INTRE REPUBLICA MOLDOVA SI
      _________________________________________________________
                      СЕРТИФИКАТ О РЕЗИДЕНТСТВЕ
   В СООТВЕТСТВИИ С КОНВЕНЦИЕЙ (СОГЛАШЕНИЕМ) ОБ ИЗБЕЖАНИИ ДВОЙНОГО
              НАЛОГООБЛОЖЕНИЯ МЕЖДУ РЕСПУБЛИКОЙ МОЛДОВА
                    И_____________________________

                      1. DATE DESPRE SOLICITANT
                      1. ИНФОРМАЦИЯ О ЗАЯВИТЕЛЕ

+--------------------------------------------------------------------+
| +----------------------------------+-----------------------------+ |
| +----------------------------------+-----------------------------+ |
| Denumirea   intreprinderii   sau     Numarul de identificare       |
| numele si prenumele                  Идентификационный номер       |
| Наименование  предприятия    или                                   |
| фамилия и имя                                                      |
|                                                                    |
| +--------------------------+---------+-----------+---------------+ |
| +--------------------------+---------+-----------+---------------+ |
| Denumirea  documentului  de  Numarul  Data         Termenul de     |
| inregistrare sau identitate  Номер    eliberarii   valabilitate    |
| Название   регистрационного           Дата выдачи  Срок действия   |
| или      идентификационного                                        |
| документа                                                          |
| +----------------+----------------+-----------------+------------+ |
| +----------------+----------------+-----------------+------------+ |
| Strada, numarul    Codul postal     Localitatea        Tara        |
| Улица, номер       Почтовый индекс  Населенный пункт   Страна      |
+--------------------------------------------------------------------+

     2. CERTIFICATUL AUTORITATII COMPETENTE A REPUBLICII MOLDOVA
       2. СЕРТИФИКАТ КОМПЕТЕНТНОГО  ОРГАНА  РЕСПУБЛИКИ  МОЛДОВА

+--------------------------------------------------------------------+
|Autoritatea competenta   certifica   ca  contribuabilul  indicat  in|
|prezenta  forma  este  rezident  al  REPUBLICII  MOLDOVA  in  sensul|
|articolului  4  al  Conventiei  (Acordului)  pentru  evitarea dublei|
|impuneri intre Republica Moldova si  _______________________________|
|, semnata la________________________________________________________|
|Компетентный орган подтверждает,  что налогоплательщик,  указанный в|
|этой  форме,  является  резидентом  РЕСПУБЛИКИ  МОЛДОВА  в понимании|
|статьи   4   Конвенции   (Соглашения)    об    избежании    двойного|
|налогообложения        между       Республикой       Молдова       и|
|_____________________________________,         подписанной         в|
|__________________________________________________________________ .|
|                                                                    |
|Prezentul certificat  este eliberat pentru intreprinderea,  persoana|
|fizica______________________________________________________________|
|Настоящий сертификат    выдан    предприятию,    физическому    лицу|
|____________________________________________________________________|
|si este valabil pentru anul fiscal _______________                  |
|и действителен на налоговый год____________                         |
|                                                                    |
|                           Numele si prenumele     _________________|
|                           Фамилия и имя           _________________|
|Locul/ Место  _____________  Semnatura/ Подпись    _________________|
|Data/ Дата    _____________  Functia/ Должность    _________________|
|Stampila/ Печать                                                    |
+--------------------------------------------------------------------+

Appendix № 2

to the Order of the Government of January 19, 2010 No. 9

Standard form - Form 2-DTA-09 "Statement for issue of the certificate on confirmation of the income tax paid in the Republic of Moldova according to the Convention (Agreement) on avoidance of double taxation"

 
            _________________ тr./ № ____________________
               La nr. _________________________________
                                 На № 
 

      
                                CERERE
  PENTRU ELIBERAREA CERTIFICATULUI PRIVIND ATESTAREA IMPOZITULUI PE
                            VENIT ACHITAT
 ]N REPUBLICA MOLDOVA, CONFORM CONVEN\IEI (ACORDULUI) PENTRU EVITAREA
              DUBLEI IMPUNERI ]NTRE REPUBLICA MOLDOVA [I
       _______________________________________________________

                                ЗАЯВЛЕНИЕ
 О ВЫДАЧЕ СЕРТИФИКАТА О ПОДТВЕРЖДЕНИИ ПОДОХОДНОГО НАЛОГА, УПЛАЧЕННОГО
  В РЕСПУБЛИКЕ МОЛДОВА СОГЛАСНО КОНВЕНЦИИ (СОГЛАШЕНИЮ) ОБ ИЗБЕЖАНИИ
                               ДВОЙНОГО
             НАЛОГООБЛОЖЕНИЯ МЕЖДУ РЕСПУБЛИКОЙ МОЛДОВА И
                _____________________________________

     1. BENEFICIARUL VENITULUI
     1. ПОЛУЧАТЕЛЬ ДОХОДА
+------------------------------------------------------------------------------------------+
|                                                                                          |
+--+----------------------------------------------------+------------------------------+---+
|  |                                                    |                              |   |
+--+----------------------------------------------------+------------------------------+---+
|                                                         Denumirea ]ntreprinderii sau     |
|                                                             numele [i prenumele          |
|                                                         Наименование предприятия или     |
|                                                                фамилия и имя             |
|                                                                                          |
+--+-----------------------

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