Free Mod 21 Form in PDF

Free Mod 21 Form in PDF

The Mod 21 form serves as an application for total or partial exemption from Portuguese withholding tax, under the convention for the avoidance of double taxation between Portugal and other countries. It identifies the beneficial owner of the income and describes the nature of the income for which exemption is claimed. This essential document aids in ensuring that individuals and entities do not pay taxes twice on the same income. To navigate the complexities of international taxation and benefit from tax treaties, ensure to fill out the Mod 21 form by clicking the button below.

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Navigating tax obligations in a global context can pose significant challenges, especially when it involves managing taxation across borders to prevent double taxation. The Mod 21 form serves as a pivotal tool for entities and individuals generating income in Portugal but residing in countries that have a double taxation treaty with Portugal. This comprehensive form, officially known as MOD. 21-RFI, enables applicants to request either a total or partial exemption from Portuguese withholding tax. The document encapsulates a broad range of income categories including dividends, interest, royalties, income from independent and dependent personal services, pensions, governmental salaries, service fees, among other incomes. Notably, the form demands the identification of the beneficial owner of the income, thus necessitating detailed financial and tax identification information. Furthermore, applicants must navigate sections concerning the certification by tax authorities of the beneficiary's residency, laying an additional emphasis on the rigorous cross-verification process engaged by international tax agreements. Instructions and specific scenarios where direct investment percentages or administrative roles in income-generating entities affect tax obligations are also addressed, underlining the form’s intent to accommodate a diverse set of financial situations. To ensure compliance and facilitate the process, the Mod 21 form gives explicit instructions, including the necessity of submission in triplicate, thereby streamlining the exemption process under the auspices of tax treaties to prevent double taxation strategically.

Preview - Mod 21 Form

DIRECÇÃO - GERAL DOS IMPOSTOS - DGCI

DSRI - Direcção de Serviços das Relações Internacionais

REPÚBLICA PORTUGUESA

Av.a Eng.o Duarte Pacheco, 28 - 4º

1099 - 013 Lisboa PORTUGAL

MINISTÉRIO DAS FINANÇAS

Tel: 351.21.3834200 Fax: 351.21.3834414

E-mail: dsri@dgci.min-financas.pt

MOD.

21-RFI

PEDIDO DE DISPENSA TOTAL OU PARCIAL DE RETENÇÃO NA FONTE DO IMPOSTO PORTUGUÊS, EFECTUADO AO ABRIGO DA CONVENÇÃO PARA EVI- TAR A DUPLA TRIBUTAÇÃO ENTRE PORTUGAL E:

CLAIM FOR TOTAL OR PARTIAL EXEMPTION FROM PORTUGUESE WITHHOLDING TAX, UNDER THE CONVENTION FOR THE AVOIDANCE OF DOUBLE TAXATION BETWEEN PORTUGAL AND:

I

IDENTIFICAÇÃO DO BENEFICIÁRIO EFECTIVO DOS RENDIMENTOS IDENTIFICATION OF THE BENEFICIAL OWNER OF THE INCOME

NOME / DENOMINAÇÃO SOCIAL

NAME / BUSINESS NAME

DOMICÍLIO FISCAL (Rua, número e andar)

 

 

 

Número de Identifi cação Fiscal (NIF) no país de residência

TAX RESIDENCE (Street, number and floor)

 

 

 

Tax Identifi cation Number (TIN) in the country of residence

 

 

 

 

 

 

CÓDIGO POSTAL

LOCALIDADE

PAÍS

 

 

NIF PORTUGUÊS (Ver instruções)

POSTCODE

CITY

COUNTRY

 

 

PORTUGUESE TIN (see instructions)

CORREIO ELECTRÓNICO:

E-MAIL:

II

IDENTIFICAÇÃO DOS RENDIMENTOS

DESCRIPTION OF THE INCOME

1 - DIVIDENDOS

1 - DIVIDENDS

1.1 - DE ACÇÕES

1.1 - FROM SHARES

 

QUANTIDADE

 

 

 

 

 

 

 

 

 

 

 

ENTIDADE EMITENTE OU CÓDIGO ISIN

 

 

NUMBER OF SHARES

 

 

 

 

 

 

 

 

 

 

 

 

ISSUER OR ISIN CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.2 - RESTANTES DIVIDENDOS

1.2 - OTHER DIVIDENDS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VALOR DA PARTICIPAÇÃO SOCIAL

 

 

 

 

 

 

 

 

 

 

 

 

 

ENTIDADE PARTICIPADA

 

 

VALUE OF THE PARTICIPATION

 

 

 

 

 

 

 

 

 

 

 

 

 

PARTICIPATED ENTITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2 - JUROS

 

 

 

 

 

 

 

 

 

 

 

2 - INTEREST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.1 - DE VALORES MOBILIÁRIOS REPRESENTATIVOS DA DÍVIDA

2.1 - FROM DEBT SECURITIES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VALOR NOMINAL

 

DESIGNAÇÃO DO VALOR MOBILIÁRIO OU

 

DATA DE AQUISIÇÃO

 

 

 

ENTIDADE EMITENTE

 

 

 

 

CÓDIGO ISIN

 

 

 

 

 

 

 

 

 

 

 

(aaaa/mm/dd)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ISSUER

 

 

NOMINAL POSITION

DESCRIPTION OF SECURITIES OR ISIN CODE

 

ACQUISITION DATE

 

 

 

 

(yyyy/mm/dd)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_________/_______/______

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_________/_______/______

 

 

 

 

 

 

 

 

2.2 - RESTANTES JUROS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.2 - OTHER INTEREST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NATUREZA DOS CRÉDITOS

 

 

 

DATA DA CONSTITUIÇÃO

 

VALOR DOS CRÉDITOS

 

 

 

NATURE OF THE DEBT CLAIMS

 

 

 

(aaaa/mm/dd)

 

VALUE OF THE DEBT CLAIMS

 

 

 

 

 

 

STARTING DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(yyyy/mm/dd)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_________/_______/______

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_________/_______/______

 

 

 

 

 

 

 

 

3 - ROYALTIES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3 - ROYALTIES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NATUREZA DAS ROYALTIES

 

 

 

 

 

 

 

 

DATA DA CELEBRAÇÃO DO CONTRATO (aaaa/mm/dd)

 

 

 

 

 

 

 

NATURE OF THE ROYALTIES

 

 

 

 

 

 

 

 

DATE OF CONCLUSION OF THE CONTRACT (yyyy/mm/dd)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_________/_______/______

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_________/_______/______

 

 

 

 

4 - TRABALHO INDEPENDENTE 4 - INDEPENDENT PERSONAL SERVICES

 

 

 

 

5 - TRABALHO DEPENDENTE 5 - INCOME FROM EMPLOYMENT

 

 

 

 

 

 

 

 

 

 

 

 

6 - PENSÕES

 

 

 

 

6. - PENSIONS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.1 - DE NATUREZA PRIVADA 6.1 - OTHER THAN FROM GOVERNMENT SERVICE

 

 

 

6.2 - DE NATUREZA PÚBLICA 6.2 - FROM GOVERNMENT SERVICE

 

 

 

 

7 - REMUNERAÇÕES PÚBLICAS 7 - INCOME FROM GOVERNMENT SERVICE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8 - PRESTAÇÕES DE SERVIÇOS 8 - SERVICES RENDERED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comissões

 

 

 

 

Outras

 

 

 

 

Especifique

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comissions

 

 

 

 

Other

 

 

 

Specify

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9 - RESTANTES RENDIMENTOS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9 - OTHER INCOME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Identifi que a natureza do rendimento

Describe the nature of the income

III

CERTIFICAÇÃO DAS AUTORIDADES FISCAIS COMPETENTES DO ESTADO DE RESIDÊNCIA DO BENEFICIÁRIO EFECTIVO CERTIFICATION BY THE COMPETENT TAX AUTHORITIES OF THE BENEFICIAL OWNER'S STATE OF RESIDENCE

CERTIFICA-SE QUE A ENTIDADE IDENTIFICADA NO QUADRO I É/FOI RESIDENTE FISCAL, NOS TERMOS DO ARTº 4º DA CONVENÇÃO PARA EVITAR A DUPLA TRIBUTA-

ÇÃO, EM

 

, NO(S) ANO(S) ______ A ______ ESTANDO SUJEITA A IMPOSTO SOBRE O RENDIMENTO.

WE CERTIFY THAT THE ENTITIY IDENTIFIED IN BOX I IS/WAS RESIDENT FOR TAX PURPOSES, UNDER ARTICLE 4 OF THE CONVENTION FOR THE AVOIDANCE OF DOU-

BLE TAXATION, IN

 

 

, IN THE YEAR(S) ______ TO ______ AND IS /WAS SUBJECT TO INCOME TAX.

LOCAL

DATA (AAAA/MM/DD

ASSINATURA E SELO OFICIAL

CITY

DATE (YYYY/MM/DD)

SIGNATURE AND OFFICIAL STAMP

_____________/________/________

ENTIDADE

ENTITY

EXEMPLAR DESTINADO À ENTIDADE OBRIGADA A EFECTUAR A RETENÇÃO NA FONTE

COPY FOR THE ENTITY OBLIGED TO WITHHOLD TAX

1

DIRECÇÃO - GERAL DOS IMPOSTOS - DGCI

DSRI - Direcção de Serviços das Relações Internacionais

REPÚBLICA PORTUGUESA

Av.a Eng.o Duarte Pacheco, 28 - 4º

1099 - 013 Lisboa PORTUGAL

MINISTÉRIO DAS FINANÇAS

Tel: 351.21.3834200 Fax: 351.21.3834414

E-mail: dsri@dgci.min-financas.pt

MOD.

21-RFI

PEDIDO DE DISPENSA TOTAL OU PARCIAL DE RETENÇÃO NA FONTE DO IMPOSTO PORTUGUÊS, EFECTUADO AO ABRIGO DA CONVENÇÃO PARA EVI- TAR A DUPLA TRIBUTAÇÃO ENTRE PORTUGAL E:

CLAIM FOR TOTAL OR PARTIAL EXEMPTION FROM PORTUGUESE WITHHOLDING TAX, UNDER THE CONVENTION FOR THE AVOIDANCE OF DOUBLE TAXATION BETWEEN PORTUGAL AND:

I

IDENTIFICAÇÃO DO BENEFICIÁRIO EFECTIVO DOS RENDIMENTOS IDENTIFICATION OF THE BENEFICIAL OWNER OF THE INCOME

NOME / DENOMINAÇÃO SOCIAL

NAME / BUSINESS NAME

DOMICÍLIO FISCAL (Rua, número e andar)

 

 

 

Número de Identifi cação Fiscal (NIF) no país de residência

TAX RESIDENCE (Street, number and floor)

 

 

 

Tax Identifi cation Number (TIN) in the country of residence

 

 

 

 

 

 

CÓDIGO POSTAL

LOCALIDADE

PAÍS

 

 

NIF PORTUGUÊS (Ver instruções)

POSTCODE

CITY

COUNTRY

 

 

PORTUGUESE TIN (see instructions)

CORREIO ELECTRÓNICO:

E-MAIL:

II

IDENTIFICAÇÃO DOS RENDIMENTOS

DESCRIPTION OF THE INCOME

1 - DIVIDENDOS

1 - DIVIDENDS

1.1 - DE ACÇÕES

1.1 - FROM SHARES

 

QUANTIDADE

 

 

 

 

 

 

 

 

 

 

 

ENTIDADE EMITENTE OU CÓDIGO ISIN

 

 

NUMBER OF SHARES

 

 

 

 

 

 

 

 

 

 

 

 

ISSUER OR ISIN CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.2 - RESTANTES DIVIDENDOS

1.2 - OTHER DIVIDENDS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VALOR DA PARTICIPAÇÃO SOCIAL

 

 

 

 

 

 

 

 

 

 

 

 

 

ENTIDADE PARTICIPADA

 

 

VALUE OF THE PARTICIPATION

 

 

 

 

 

 

 

 

 

 

 

 

 

PARTICIPATED ENTITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2 - JUROS

 

 

 

 

 

 

 

 

 

 

 

2 - INTEREST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.1 - DE VALORES MOBILIÁRIOS REPRESENTATIVOS DA DÍVIDA

2.1 - FROM DEBT SECURITIES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VALOR NOMINAL

 

DESIGNAÇÃO DO VALOR MOBILIÁRIO OU

 

DATA DE AQUISIÇÃO

 

 

 

ENTIDADE EMITENTE

 

 

 

 

CÓDIGO ISIN

 

 

 

(aaaa/mm/dd)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ISSUER

 

 

NOMINAL POSITION

DESCRIPTION OF SECURITIES OR ISIN CODE

 

ACQUISITION DATE

 

 

 

 

(yyyy/mm/dd)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_________/_______/______

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_________/_______/______

 

 

 

 

 

 

 

 

2.2 - RESTANTES JUROS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.2 - OTHER INTEREST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NATUREZA DOS CRÉDITOS

 

 

 

DATA DA CONSTITUIÇÃO

 

VALOR DOS CRÉDITOS

 

 

 

NATURE OF THE DEBT CLAIMS

 

 

 

(aaaa/mm/dd)

 

VALUE OF THE DEBT CLAIMS

 

 

 

 

 

 

STARTING DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(yyyy/mm/dd)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_________/_______/______

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_________/_______/______

 

 

 

 

 

 

 

 

3 - ROYALTIES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3 - ROYALTIES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NATUREZA DAS ROYALTIES

 

 

 

 

 

 

 

 

DATA DA CELEBRAÇÃO DO CONTRATO (aaaa/mm/dd)

 

 

 

 

 

 

 

NATURE OF THE ROYALTIES

 

 

 

 

 

 

 

 

DATE OF CONCLUSION OF THE CONTRACT (yyyy/mm/dd)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_________/_______/______

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_________/_______/______

 

 

 

 

4 - TRABALHO INDEPENDENTE 4 - INDEPENDENT PERSONAL SERVICES

 

 

 

 

5 - TRABALHO DEPENDENTE 5 - INCOME FROM EMPLOYMENT

 

 

 

 

 

 

 

 

 

 

 

 

6 - PENSÕES

 

 

 

 

6. - PENSIONS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.1 - DE NATUREZA PRIVADA 6.1 - OTHER THAN FROM GOVERNMENT SERVICE

 

 

 

6.2 - DE NATUREZA PÚBLICA 6.2 - FROM GOVERNMENT SERVICE

 

 

 

 

7 - REMUNERAÇÕES PÚBLICAS 7 - INCOME FROM GOVERNMENT SERVICE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8 - PRESTAÇÕES DE SERVIÇOS 8 - SERVICES RENDERED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comissões

 

 

 

 

Outras

 

 

 

 

Especifique

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comissions

 

 

 

 

Other

 

 

 

Specify

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9 - RESTANTES RENDIMENTOS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9 - OTHER INCOME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Identifi que a natureza do rendimento

Describe the nature of the income

III

CERTIFICAÇÃO DAS AUTORIDADES FISCAIS COMPETENTES DO ESTADO DE RESIDÊNCIA DO BENEFICIÁRIO EFECTIVO CERTIFICATION BY THE COMPETENT TAX AUTHORITIES OF THE BENEFICIAL OWNER'S STATE OF RESIDENCE

CERTIFICA-SE QUE A ENTIDADE IDENTIFICADA NO QUADRO I É/FOI RESIDENTE FISCAL, NOS TERMOS DO ARTº 4º DA CONVENÇÃO PARA EVITAR A DUPLA TRIBUTA-

ÇÃO, EM

 

, NO(S) ANO(S) ______ A ______ ESTANDO SUJEITA A IMPOSTO SOBRE O RENDIMENTO.

WE CERTIFY THAT THE ENTITIY IDENTIFIED IN BOX I IS/WAS RESIDENT FOR TAX PURPOSES, UNDER ARTICLE 4 OF THE CONVENTION FOR THE AVOIDANCE OF DOU-

BLE TAXATION, IN

 

 

, IN THE YEAR(S) ______ TO ______ AND IS /WAS SUBJECT TO INCOME TAX.

LOCAL

DATA (AAAA/MM/DD

ASSINATURA E SELO OFICIAL

CITY

DATE (YYYY/MM/DD)

SIGNATURE AND OFFICIAL STAMP

_____________/________/________

ENTIDADE

ENTITY

EXEMPLAR DESTINADO À ADMINISTRAÇÃO FISCAL DO ESTADO DE RESIDÊNCIA DO BENEFICIÁRIO DO RENDIMENTO

COPY FOR THE TAX AUTHORITIES OF THE BENEFICIARY'S COUNTRY OF RESIDENCE

2

DIRECÇÃO - GERAL DOS IMPOSTOS - DGCI

DSRI - Direcção de Serviços das Relações Internacionais

REPÚBLICA PORTUGUESA

Av.a Eng.o Duarte Pacheco, 28 - 4º

1099 - 013 Lisboa PORTUGAL

MINISTÉRIO DAS FINANÇAS

Tel: 351.21.3834200 Fax: 351.21.3834414

E-mail: dsri@dgci.min-financas.pt

MOD.

21-RFI

PEDIDO DE DISPENSA TOTAL OU PARCIAL DE RETENÇÃO NA FONTE DO IMPOSTO PORTUGUÊS, EFECTUADO AO ABRIGO DA CONVENÇÃO PARA EVI- TAR A DUPLA TRIBUTAÇÃO ENTRE PORTUGAL E:

CLAIM FOR TOTAL OR PARTIAL EXEMPTION FROM PORTUGUESE WITHHOLDING TAX, UNDER THE CONVENTION FOR THE AVOIDANCE OF DOUBLE TAXATION BETWEEN PORTUGAL AND:

I

IDENTIFICAÇÃO DO BENEFICIÁRIO EFECTIVO DOS RENDIMENTOS IDENTIFICATION OF THE BENEFICIAL OWNER OF THE INCOME

NOME / DENOMINAÇÃO SOCIAL

NAME / BUSINESS NAME

DOMICÍLIO FISCAL (Rua, número e andar)

 

 

 

Número de Identifi cação Fiscal (NIF) no país de residência

TAX RESIDENCE (Street, number and floor)

 

 

 

Tax Identifi cation Number (TIN) in the country of residence

 

 

 

 

 

 

CÓDIGO POSTAL

LOCALIDADE

PAÍS

 

 

NIF PORTUGUÊS (Ver instruções)

POSTCODE

CITY

COUNTRY

 

 

PORTUGUESE TIN (see instructions)

CORREIO ELECTRÓNICO:

E-MAIL:

II

IDENTIFICAÇÃO DOS RENDIMENTOS

DESCRIPTION OF THE INCOME

1 - DIVIDENDOS

1 - DIVIDENDS

1.1 - DE ACÇÕES

1.1 - FROM SHARES

 

QUANTIDADE

 

 

 

 

 

 

 

 

 

 

 

ENTIDADE EMITENTE OU CÓDIGO ISIN

 

 

NUMBER OF SHARES

 

 

 

 

 

 

 

 

 

 

 

 

ISSUER OR ISIN CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.2 - RESTANTES DIVIDENDOS

1.2 - OTHER DIVIDENDS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VALOR DA PARTICIPAÇÃO SOCIAL

 

 

 

 

 

 

 

 

 

 

 

 

 

ENTIDADE PARTICIPADA

 

 

VALUE OF THE PARTICIPATION

 

 

 

 

 

 

 

 

 

 

 

 

 

PARTICIPATED ENTITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2 - JUROS

 

 

 

 

 

 

 

 

 

 

 

2 - INTEREST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.1 - DE VALORES MOBILIÁRIOS REPRESENTATIVOS DA DÍVIDA

2.1 - FROM DEBT SECURITIES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VALOR NOMINAL

 

DESIGNAÇÃO DO VALOR MOBILIÁRIO OU

 

DATA DE AQUISIÇÃO

 

 

 

ENTIDADE EMITENTE

 

 

 

 

CÓDIGO ISIN

 

 

 

(aaaa/mm/dd)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ISSUER

 

 

NOMINAL POSITION

DESCRIPTION OF SECURITIES OR ISIN CODE

 

ACQUISITION DATE

 

 

 

 

(yyyy/mm/dd)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_________/_______/______

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_________/_______/______

 

 

 

 

 

 

 

 

2.2 - RESTANTES JUROS

 

2.2 - OTHER INTEREST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NATUREZA DOS CRÉDITOS

 

 

 

DATA DA CONSTITUIÇÃO

 

VALOR DOS CRÉDITOS

 

 

 

NATURE OF THE DEBT CLAIMS

 

 

 

(aaaa/mm/dd)

 

VALUE OF THE DEBT CLAIMS

 

 

 

 

 

 

STARTING DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(yyyy/mm/dd)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_________/_______/______

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_________/_______/______

 

 

 

 

 

 

 

 

3 - ROYALTIES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3 - ROYALTIES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NATUREZA DAS ROYALTIES

 

 

 

 

 

 

 

 

DATA DA CELEBRAÇÃO DO CONTRATO (aaaa/mm/dd)

 

 

 

 

 

 

 

NATURE OF THE ROYALTIES

 

 

 

 

 

 

 

 

DATE OF CONCLUSION OF THE CONTRACT (yyyy/mm/dd)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_________/_______/______

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_________/_______/______

 

 

 

 

4 - TRABALHO INDEPENDENTE 4 - INDEPENDENT PERSONAL SERVICES

 

 

 

 

5 - TRABALHO DEPENDENTE 5 - INCOME FROM EMPLOYMENT

 

 

 

 

 

 

 

 

 

 

 

 

6 - PENSÕES

 

 

 

 

6. - PENSIONS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.1 - DE NATUREZA PRIVADA 6.1 - OTHER THAN FROM GOVERNMENT SERVICE

 

 

 

6.2 - DE NATUREZA PÚBLICA 6.2 - FROM GOVERNMENT SERVICE

 

 

 

 

7 - REMUNERAÇÕES PÚBLICAS 7 - INCOME FROM GOVERNMENT SERVICE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8 - PRESTAÇÕES DE SERVIÇOS 8 - SERVICES RENDERED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comissões

 

 

 

 

Outras

 

 

 

 

Especifique

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comissions

 

 

 

 

Other

 

 

 

Specify

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9 - RESTANTES RENDIMENTOS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9 - OTHER INCOME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Identifi que a natureza do rendimento

Describe the nature of the income

III

CERTIFICAÇÃO DAS AUTORIDADES FISCAIS COMPETENTES DO ESTADO DE RESIDÊNCIA DO BENEFICIÁRIO EFECTIVO CERTIFICATION BY THE COMPETENT TAX AUTHORITIES OF THE BENEFICIAL OWNER'S STATE OF RESIDENCE

CERTIFICA-SE QUE A ENTIDADE IDENTIFICADA NO QUADRO I É/FOI RESIDENTE FISCAL, NOS TERMOS DO ARTº 4º DA CONVENÇÃO PARA EVITAR A DUPLA TRIBUTA-

ÇÃO, EM

 

, NO(S) ANO(S) ______ A ______ ESTANDO SUJEITA A IMPOSTO SOBRE O RENDIMENTO.

WE CERTIFY THAT THE ENTITIY IDENTIFIED IN BOX I IS/WAS RESIDENT FOR TAX PURPOSES, UNDER ARTICLE 4 OF THE CONVENTION FOR THE AVOIDANCE OF DOU-

BLE TAXATION, IN

 

 

, IN THE YEAR(S) ______ TO ______ AND IS /WAS SUBJECT TO INCOME TAX.

LOCAL

DATA (AAAA/MM/DD

ASSINATURA E SELO OFICIAL

CITY

DATE (YYYY/MM/DD)

SIGNATURE AND OFFICIAL STAMP

_____________/________/________

ENTIDADE

ENTITY

EXEMPLAR DESTINADO AO BENEFICIÁRIO DO RENDIMENTO

COPY FOR THE BENEFICIARY OF THE INCOME

3

IV

QUESTIONÁRIO (A RESPONDER PELO BENEFICIÁRIO DO RENDIMENTO)

QUESTIONS (TO BE ANSWERED BY THE BENEFICIAL OWNER)

A - A PREENCHER POR PESSOAS SINGULARES E POR PESSOAS COLECTIVAS

A - TO BE FILLED IN BY INDIVIDUALS, COMPANIES AND ANY OTHER BODY OF PERSONS

1 - Dispõe de estabelecimento estável ou instalação fi xa em Portugal ? 1 - Do you have a permanent establishment or a fi xed base in Portugal?

2 - Participa no capital social da(s) entidade(s) devedora(s) dos rendimentos em percentagem igual ou superior a 10% ? 2 - Do you participate in the share capital of the debtor(s) of income in a percentage of 10% or more?

Em caso afi rmativo, indique a(s) entidade(s) e a(s) percentagem(ns) correspondente(s)

If yes, please indicate the debtor(s) and the corresponding percentage(s)

Sim Yes

Sim Yes

Não No

Não No

________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________

3 - Pertence aos órgãos sociais da(s) entidade(s) devedora(s) dos rendimentos ?Sim Yes

3 - Do you belong to the board of directors or to the supervisory board of the debtor(s) of the income?

Em caso afirmativo especifique

If yes, please specify

Não No

B - A PREENCHER SOMENTE POR PESSOAS SINGULARES

B - TO BE FILLED IN ONLY BY INDIVIDUALS

1

- No(s) ano(s) civil(is) em que os rendimentos vão ser pagos ou colocados à sua disposição, vai residir em Portugal ?

 

1

- Will you stay in Portugal during the calendar year(s) in which the income will be paid or put at your disposal?

Sim Yes

 

 

Em caso afi rmativo, indique a estimativa do número de dias de permanência

If yes, please indicate the estimated number of days of your stay

Não No

2

- Dispõe de habitação permanente em Portugal ?

Sim Yes

 

 

Não No

 

 

 

 

 

 

 

 

2

- Do you have a permanent home in Portugal?

 

 

 

 

 

 

 

 

 

 

 

 

Em caso afi rmativo, indique o endereço

 

 

 

 

 

 

 

If yes, please indicate the address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

- Indique a sua data de nascimento (AAAA/MM/DD)

 

 

 

e a nacionalidade

3

- Please indicate your date of birth (YYYY/MM/DD) __________/________/________

and your nationality

 

 

V

IDENTIFICAÇÃO DO INTERMEDIÁRIO FINANCEIRO NÃO RESIDENTE EM PORTUGAL IDENTIFICATION OF THE FINANCIAL INTERMEDIARY NON RESIDENT IN PORTUGAL

NOME/DENOMINAÇÃO SOCIAL

 

 

 

NAME/BUSINESS NAME

 

 

 

 

 

 

 

 

 

 

 

DOMICÍLIO FISCAL

 

 

NIF no país de residência

TAX RESIDENCE

 

 

 

 

TIN in the country of residence

 

 

 

 

 

 

 

 

CÓDIGO POSTAL

LOCALIDADE

 

PAÍS

POSTCODE

CITY

 

COUNTRY

 

 

 

 

VI

IDENTIFICAÇÃO DA ENTIDADE RESIDENTE EM PORTUGAL QUE SE ENCONTRA OBRIGADA A EFECTUAR A RETENÇÃO NA FONTE IDENTIFICATION OF THE ENTITY RESIDENT IN PORTUGAL OBLIGED TO WITHHOLD TAX

NOME/DENOMINAÇÃO SOCIAL

Número de Identifi cação Fiscal (NIF)

NAME/BUSINESS NAME

Tax Identifi cation Number (TIN)

VII

IDENTIFICAÇÃO DO REPRESENTANTE LEGAL DO BENEFICIÁRIO EFECTIVO DOS RENDIMENTOS IDENTIFICATION OF THE BENEFICIAL OWNER’S LEGAL REPRESENTATIVE

NOME/DENOMINAÇÃO SOCIAL

Número de Identifi cação Fiscal (NIF)

NAME/BUSINESS NAME

Tax Identifi cation Number (TIN)

VIII

DECLARAÇÃO DO BENEFICIÁRIO EFECTIVO DOS RENDIMENTOS OU DO SEU REPRESENTANTE LEGAL STATEMENT BY THE BENEFICIAL OWNER OR BY THE LEGAL REPRESENTATIVE

Declaro que sou (a entidade identificada no Quadro I é) o beneficiário efectivo dos rendimentos mencionados no presente formulário e que estão correctos todos os elementos nele indicados. Mais declaro que estes rendimentos não estão efectivamente conexos com qualquer estabelecimento estável ou instalação fi xa localizados em Portugal.

I state that I am (the entity identified in Box I is) the beneficial owner of the

income mentioned in this form and that the information included here-

in is accurate. I further declare that this income is not effectively connected

with any permanent establishment or fixed base situated in Portugal.

Local

 

 

 

Data (AAAA/MM/DD)

City

 

 

 

Date (YYYY/MM/DD)

 

 

 

 

 

 

 

 

_____________/________/________

Assinatura:

 

 

 

 

Signature:

 

 

 

 

 

 

 

 

 

Signatário Autorizado:

 

 

Função:

Nome

 

 

Title/Position:

Authorized signatory:

 

 

 

 

Name

 

 

 

 

 

 

 

 

 

Form. mod. 21 - RFI (Pedido de dispensa total ou parcial de retenção na fonte do imposto português)

INSTRUÇÕES DE PREENCHIMENTO

OBSERVAÇÕES PRÉVIAS

O presente formulário destina-se a solicitar a dispensa total ou parcial de retenção na fonte do imposto português, quando o beneficiário do rendimento seja residente em país com o qual Portugal tenha celebrado Convenção para Evitar a Dupla Tributação.

Deve ser preenchido, em triplicado, pelo beneficiário efectivo dos rendimentos obtidos em território português (ou pelo seu representante legal em Portugal) destinando-se cada um dos exemplares, depois de certificados pela autoridade fiscal competente do Estado da residência do beneficiário efectivo dos rendimentos, à entidade indicada na parte inferior direita das páginas que o compõem. O formulário é válido pelo prazo máximo de um ano. O beneficiário dos rendimentos deverá informar imediatamente a entidade devedora ou pagadora caso se verifiquem alterações nos pressupostos de que depende a dispensa total ou parcial de retenção na fonte. No caso de dividendos de acções e juros de valores mobiliários representativos de dívida, o formulário deverá ser entregue ao intermediário financeiro junto do qual o beneficiário efectivo tem a conta de valores mobiliários que, por sua vez, o reencaminhará para a entidade residente em Portugal obrigada a efectuar a retenção na fonte.

Qualquer que seja a natureza dos rendimentos indicados no quadro II a entrega do formulário junto da entidade portuguesa obrigada a efectuar a retenção na fonte deverá verificar-se até ao termo do prazo estabelecido para a entrega do respectivo imposto. Essa entidade conservará o exemplar que lhe foi remetido, devendo apresentá-lo apenas quando solicitado e no prazo que for fixado.

O pedido de dispensa de retenção na fonte só se considera entregue quando o formulário estiver integral e correctamente preenchido.

Este formulário pode ser obtido junto das autoridades fiscais competentes dos Estados com os quais Portugal celebrou Convenção para Evitar Dupla Tributação, e ainda via Internet, na página www.dgci.min-financas.pt, devendo, neste último caso, a quarta página ser impressa em triplicado no verso das três primeiras.

QUADRO I

Destina-se à identificação do beneficiário efectivo dos rendimentos. O nome/denominação social, bem como a morada, devem estar completos e, quando preenchidos manualmente, devem ser inscritos com letra maiúscula. O primeiro Número de Identificação Fiscal (NIF) a inscrever corresponde ao do país de residência do beneficiário dos rendimentos. Deverá ainda ser preenchido o NIF português que, caso não exista, será obrigatoriamente requerido pela entidade obrigada a efectuar a retenção na fonte de imposto. A indicação do endereço de correio electrónico (e-mail) é facultativa.

QUADRO II

Neste quadro, destinado à identificação dos rendimentos, deve assinalar-se a natureza dos rendimentos que vão ser obtidos em Portugal de acordo com as definições e/ou âmbito de aplicação dos artigos da Convenção Para Evitar a Dupla Tributação aplicável. Em particular, o campo 8 (prestações de serviços) deve ser assinalado relativamente aos casos que caiam no âmbito do artº 7º da Convenção, isto é, quando se trate de rendimentos de prestações de serviços a incluir no lucro das empresas.

No campo 1.1, o código ISIN é de preenchimento obrigatório, quando exista, dispensando a indicação da entidade emitente. Deverá ser entregue um único formulário a cada entidade residente em Portugal obrigada a efectuar a retenção na fonte de imposto sobre rendimentos obtidos em território português.

No caso de as linhas serem insufi cientes, deverão ser utilizados os formulários que forem necessários.

QUADRO III

Este quadro é reservado à certificação pelas autoridades fiscais competentes do Estado da residência do beneficiário dos rendimentos.

QUADRO IV

Responder SIM ou NÃO às questões colocadas, especifi cando quando aplicável.

QUADRO V

Este quadro só deve ser preenchido nos casos em que o beneficiário detém acções ou valores mobiliários representativos de dívida em conta aberta junto de um intermediário fi nanceiro não residente em Portugal.

Como se referiu em “observações prévias”, será esta entidade que reencaminhará o formulário, depois de devidamente preenchido e certifi cado, para a entidade residente em Portugal obrigada a efectuar a retenção na fonte.

QUADRO VI

Quadro destinado à identificação da entidade residente em Portugal que se encontra obrigada a efectuar a retenção na fonte do imposto.

QUADRO VII

Destina-se à identificação do representante legal do beneficiário dos rendimentos, a identificar obrigatoriamente apenas nos casos em que este pretenda que seja o seu representante legal a solicitar a dispensa total ou parcial da retenção na fonte do imposto devido em Portugal.

QUADRO VIII

A declaração constante deste quadro deve ser assinada pelo beneficiário efectivo, ou pelo seu representante legal em Portugal.

Form mod. 21 – RFI (Claim for total or partial exemption from Portuguese withholding tax)

INSTRUCTIONS FOR COMPLETION

PRELIMINARY OBSERVATIONS:

The purpose of this form is to claim total or partial exemption from Portuguese withholding tax, in cases where the beneficial owner is resident in a country with which Portugal has concluded a Convention for the Avoidance of Double Taxation.

It has to be completed in triplicate by the beneficial owner of the income derived in Portuguese territory (or by the legal representative in Portugal). After each copy is duly certified by the competent tax authority of the beneficial owner’s State of residence, it must be sent to the entity indicated at the right bottom. This form shall be valid for a maximum period of one year. The beneficial owner of the income must immediately inform the payer if any of the conditions to benefit from partial or total relief from withholding tax ceases to be met. As to dividends from shares and interest from debt securities, the form must be sent to the financial intermediary that holds the securities in an account on behalf of beneficial owner. Afterwards the financial intermediary will forward the form to the entity resident in Portugal obliged to withhold tax.

Whatever the nature of the income in box II, the form must be submitted to the Portuguese resident entity obliged to withhold tax, not later than the tax due date. This entity will keep the copy and will present it only when required within the established deadline.

The claim for total or partial exemption from Portuguese withholding tax is deemed to be submitted only when the form is entirely and correctly filled in.

This form is available at the competent tax authorities of the States with which Portugal has concluded a Convention for the Avoid- ance of Double Taxation and also on the Internet at www.dgci.min-financas.pt. In case it is downloaded from this webpage, the fourth page has to be printed out in triplicate on the reverse side of the three first pages.

BOX I

This box is intended to identify the beneficial owner of the income. The name /business name, as well as the address, must be complete and in capital letters when handwritten. The first Tax Identification Number (TIN) to enter is the one from the beneficial owner’s country of residence. The Portuguese TIN must also be entered. In case it does not exist, it must be required by the entity obliged to withhold tax. The indication of the e-mail address is optional.

BOX II

This box is intended to identify the income. The nature of the income that will be derived in Portugal, accordingly to the definitions and/or application scope of the articles of the applicable Convention for the Avoidance of Double Taxation, must be marked. In particular, box 8 (services rendered) must be marked in cases provided for under Article 7 of the Convention i.e. if the income derived as a consideration for services rendered is included in the business profits.

In box 1.1 it is mandatory to complete the ISIN code, whenever there is one, being not necessary to indicate the issuer.

Each entity resident in Portugal obliged to withhold tax from income derived in Portuguese territory must receive a single form. If there are not enough lines, please use the number of forms necessary.

BOX III

This box is restricted to the certifi cation by the competent tax authorities of the benefi cial owner‘s State of residence.

BOX IV

Answer “Yes” or “No” to the questions and specify whenever applicable.

BOX V

This box must only be completed in cases where the shares or the debt securities are held in an account by a financial intermedi- ary non resident in Portugal on behalf of the beneficial owner.

As above referred in the preliminary observations, this entity will forward the form, after duly filled in and certified, to the entity resident in Portugal obliged to withhold tax.

BOX VI

This box is intended to identify the entity resident in Portugal which is obliged to withhold tax.

BOX VII

This box is intended to identify the beneficial owner’s legal representative, this completion is only mandatory in cases, where the benefi cial owner wants the legal representative to claim the total or partial exemption from withholding tax due in Portugal.

BOX VIII

The statement in this box must be signed by the benefi cial owner of the income or by the legal representative in Portugal.

Document Specs

Fact Name Description
Purpose of Form MOD. 21-RFI This form is used to request a total or partial exemption from Portuguese withholding tax under Double Taxation Treaties.
Beneficiary Identification Section I requires detailed information about the beneficial owner of the income, including name, fiscal address, and Tax Identification Number (TIN) in both the country of residence and Portugal.
Income Description Section II outlines the type of income for which the exemption is being requested, such as dividends, interest, royalties, or income from employment, and requires specific details depending on the income type.
Authority Certification Section III requires certification by the competent tax authorities of the beneficial owner's country of residence, confirming fiscal residency and subjectivity to income tax under the applicable Double Taxation Treaty articles.

Instructions on Writing Mod 21

After completing the Mod 21-RFI form, it sets in motion the process of requesting a total or partial exemption from Portuguese withholding tax under double taxation treaty provisions. Knowing each step ensures accurate submission, which is pivotal for efficient processing. Filling it out correctly guides the relevant authorities in determining your eligibility for the requested tax relief. Each section of the form must be completed with care, with specific details about the beneficiary, income type, and certification by the tax authority in the beneficiary's country of residence.

  1. Identify the beneficial owner of the income under Section I, including name or business name, fiscal address, Tax Identification Number (TIN) in both the country of residence and Portugal (if applicable), and email.
  2. In Section II, describe the income for which exemption from Portuguese withholding tax is being requested. This includes specifying the type of income, such as dividends, interests, royalties, and others, along with the required details like quantity, issuer, and value.
  3. Section III must be completed by the competent tax authorities of the beneficial owner's state of residence. It certifies the beneficiary's tax residency and subjects them to tax on their income, including the years relevant for the exemption request.
  4. Sections IV and V contain questions for the beneficial owner about their connection to Portugal, including details about permanent establishments, shareholdings, and personal stays in Portugal. This section helps clarify the beneficiary’s tax situation in relation to Portugal.
  5. If applicable, provide details about the financial intermediary non-resident in Portugal under Section V. This is necessary only if the beneficiary holds stocks or debt securities in an account with a non-resident financial intermediary.
  6. Section VI requires identification of the entity resident in Portugal that is obliged to withhold tax.
  7. Include the information of the legal representative of the beneficial owner in Section VII, if the request is being made through a legal representative.
  8. Finally, the beneficial owner or their legal representative must complete Section VIII, declaring the accuracy of the information provided and the true ownership of the income. This includes signing and dating the form.

Once all sections are duly filled, review the form to ensure all information is accurate and complete. The form should be submitted in triplicate, with each copy intended for different entities as required. Proper completion and submission of the Mod 21-RFI form is crucial for the timely processing of your tax exemption request.

Understanding Mod 21

What is the Mod 21 form used for?

The Mod 21 form, formally known as Mod. 21-RFI, is a document used to request total or partial exemption from Portuguese withholding tax. This exemption is specified under the Double Taxation Treaty between Portugal and the resident country of the income beneficiary. It's applicable to individuals or entities receiving income from Portugal that may be subject to withholding tax but qualify for relief under a tax treaty.

Who needs to fill out the Mod 21 form?

This form must be completed by the beneficial owner of the income earned in Portugal or their legal representative. The beneficial owner refers to the individual or entity that ultimately receives the income and has the right to use it as they see fit. If the beneficial owner is not directly dealing with the income's administrative processes, a legal representative appointed in Portugal can fill out and submit the form on their behalf.

What types of income does the Mod 21 form cover?

The Mod 21 form covers various types of income, including dividends, interest, royalties, income from independent personal services, income from employment, pensions (both public and private), income from government services, fees for services rendered, and other income. This broad coverage is designed to cater to different forms of income that residents of countries with which Portugal has a double taxation agreement might receive.

How is the Mod 21 form submitted?

The form should be completed in triplicate and submitted to the competent tax authority in the beneficiary's country of residence for certification. Once certified, one copy is for the entity obliged to withhold tax in Portugal, another copy is kept by the taxpayer, and the third is for the tax authorities in the beneficiary's residence country. For dividends and interest from securities, the form should be submitted through the financial intermediary managing the securities account.

Is there a validity period for the Mod 21 form?

Yes, the Mod 21 form is valid for a maximum period of one year. Beneficiaries should renew their request for withholding tax exemption annually using this form. Additionally, any changes in circumstances that affect the exemption must be promptly communicated to the entity responsible for withholding the tax in Portugal.

Can the Mod 21 form be obtained and submitted online?

While the Mod 21 form can be downloaded from the official website of Portugal's tax authorities, the current process requires the form to be filled out in print and submitted through traditional mail or in person. This requirement ensures that the form is duly signed and certified by the competent tax authorities in the beneficiary's country of residence before submission to the Portuguese authorities or the withholding entity.

Common mistakes

Filling out the Mod 21 form, applicants frequently make mistakes that can delay or impact their requests for tax relief under the double taxation treaty between Portugal and their country of residence. One common error is not providing complete information regarding the beneficiary’s identification (Quadro I). Applicants sometimes fail to include their full name, business name, and fiscal address in detail, including the street, number, and floor if applicable. Additionally, when manually completing the form, it’s crucial that this information is written in capital letters to ensure clarity.

Another area where mistakes often occur is in the identification of income (Quadro II). It’s essential to clearly specify the type of income being declared, such as dividends from shares (1.1) or debt securities interest (2.1), and to provide all required details like the value of the participation or the nominal value of securities. Omitting the ISIN code when available is a particular oversight that applicants should avoid, as this code helps to uniquely identify the securities involved.

A significant but sometimes overlooked part of the Mod 21 form is the certification by the competent tax authorities of the beneficial owner's state of residence (Quadro III). This certification verifies the applicant’s status as a resident for tax purposes under the relevant double taxation treaty. Applicants often forget to ensure this section is completed, which is crucial for the processing of their claim.

Errors can also stem from not accurately responding to the questionnaire (Quadro IV) intended for the beneficial owner of the income. It’s important to answer all questions truthfully and clearly, specifying any relevant details. For instance, indicating whether the applicant has a permanent establishment or a fixed base in Portugal is fundamental for determining eligibility for the tax relief.

Another mistake involves the identification of the financial intermediary non-resident in Portugal (Quadro V), when applicable. Applicants who hold shares or debt securities through a financial intermediary outside Portugal need to provide detailed information about this intermediary. Neglecting to fill in this part or providing incomplete information can hinder the application's success.

Lastly, applicants often forget to submit the Mod 21 form to the right entity or within the established deadline. It’s crucial to deliver the form timely to the Portuguese entity obliged to withhold tax, ensuring that all information is correct and fully completed. Holding on to the form until after the receipt of income or failing to correctly identify the entity responsible for withholding tax can result in unnecessary delays or denial of the claim.

Documents used along the form

When navigating the intricate processes related to taxes and international agreements on double taxation, several essential forms and documents usually accompany the MOD. 21-RFI form. Each document plays a crucial role in ensuring comprehensive compliance with existing tax laws and treaties.

  • Form 22-RFI: This document is a continuation of the Form 21-RFI, providing additional space for declaring income types not covered by the initial form. It's used when the range of income sources exceeds the capacity of Form 21-RFI.
  • Power of Attorney: This legal document authorizes a specific representative to act on behalf of the beneficial owner. It's crucial for situations where the beneficial owner cannot personally attend to the tax matters in question.
  • Tax Residency Certificate: Issued by the competent tax authority of the taxpayer's country of residence, this certificate proves the taxpayer's fiscal domicile. It's essential for applying the appropriate double taxation treaty benefits.
  • Financial Identification Form: Necessary for entities or individuals receiving payments from governmental or public sources, this form helps to identify the account where funds should be deposited or from which fees will be deducted.
  • Declaration of Beneficial Ownership: This declaration, typically required by financial institutions, clarifies the identity of the beneficial owners of an entity. It is crucial for fulfilling anti-money laundering regulations.
  • Corporate Documents: For entities, a set of corporate documents including the certificate of incorporation, articles of association, and business registration documents are often required to establish the legal and operational status of the corporation.
  • Proof of Income: Documents such as bank statements, payslips, or dividend certificates prove the source and amount of income being declared. This evidence supports the claim for exemption or reduced taxation under double taxation treaties.

Together, these documents form a comprehensive dossier that individuals and entities must prepare to navigate the complexities of tax laws effectively, especially when seeking to avoid double taxation. Each document serves as a testament to the legitimacy and accuracy of the claims made within the MOD. 21-RFI form, ensuring that tax authorities have all the necessary information to process these requests efficiently.

Similar forms

The form W-8BEN, "Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting," is akin to the Mod 21 form in that it is utilized by non-U.S. persons to assert their foreign status and, where applicable, claim benefits under an income tax treaty. Both forms serve to certify the beneficial owner's tax residency and claim exemptions or reductions from withholding tax on certain types of income, such as dividends, interest, and royalties.

The W-8BEN-E form is designed for entities to certify their status for purposes of withholding and reporting under the Foreign Account Tax Compliance Act (FATCA) and is comparable to Mod 21 in its function for entities rather than individuals. These documents are vital for entities to claim tax treaty benefits and confirm their compliance with relevant tax regulations, helping reduce or eliminate withholding tax where treaties provide for such relief.

The 1042-S form, "Foreign Person's U.S. Source Income Subject to Withholding," is used to report amounts paid to foreign persons, including individuals, corporations, and partnerships, that are subject to income tax withholding. Similar to the Mod 21 form, it plays a role in the taxation of international income flows and aids in ensuring the correct tax treatment of diverse income types according to treaty positions or default tax withholding rates.

A Certificate of Residence is a document issued by a tax authority proving the tax residency of an individual or legal entity. This certificate mirrors the section of the Mod 21 form that certifies the tax residence of the beneficial owner by the competent authorities. Both documents are crucial for applying tax treaty benefits to prevent double taxation on the same income in two countries.

Form 6166, a U.S. Residency Certification, serves a purpose similar to a key component of the Mod 21 form by certifying the U.S. tax residency status of a claimant seeking benefits under an income tax treaty. These certifications are central to validating the claimant's eligibility for reduced tax rates on international payments such as dividends, interests, and royalties.

The 8233 form, "Exemption From Withholding on Compensation for Independent (and Certain Dependent) Personal Services of a Nonresident Alien Individual," is related to the Mod 21 in that it is used by individuals to claim exemptions from withholding tax on income earned in the foreign country. Both documents facilitate the correct tax treatment of individuals providing services across borders.

The SS-4 form, used to apply for an Employer Identification Number (EIN), differs in specific function but is similar in the broader context of international tax compliance. Where Mod 21 helps in applying tax treaty benefits, the SS-4 is a preliminary step for entities needing identification in the tax system to potentially file other forms related to international transactions and withholding.

A Request for Taxpayer Identification Number and Certification, known as form W-9, is used domestically within the U.S. but shares a common purpose with parts of the Mod 21 form in identifying the taxpayer for reporting and withholding purposes. Both forms help in ensuring the accurate application of tax rules to payments made to taxpayers, whether domestic or international.

The form 8802, "Application for United States Residency Certification," is used to request a certificate that confirms a person or company's residency in the U.S. for the purposes of claiming income tax treaty benefits with foreign countries. It parallels the Mod 21 form's function for Portuguese tax residents in establishing residency to avoid double taxation.

The Schedule K-1 (Form 1065) is a document used in the U.S. to report incomes, deductions, and credits of a partnership, which bears resemblance to the income reporting element of the Mod 21. Both documents are essential for properly disclosing and potentially applying treaty-based or statutory exemptions to certain types of cross-border income between treaty partners.

Dos and Don'ts

When approaching the task of filling out the Mod 21 form, which is crucial for claiming total or partial exemption from Portuguese withholding tax under double taxation agreements, certain practices should be followed to ensure that the process is done accurately and effectively. Here are some do's and don'ts that are essential for anyone completing this form:

  • Do ensure all personal and business names are completely and accurately filled in, matching the details in official documents.
  • Do provide the complete address including street, number, floor, and postal code accurately to avoid any processing delays.
  • Do include the Tax Identification Number (TIN) from your country of residence as well as the Portuguese TIN if available.
  • Do specify the nature of the income accurately in the relevant sections to ensure correct exemption application.
  • Do not leave out the e-mail address, as this can facilitate faster communication regarding the form.
  • Do not forget to check the details around the issuance of shares or securities, including the ISIN code, as this is crucial information.
  • Do ensure that all the information regarding the nature of the debt claims, including the starting date and value, is provided.
  • Do not overlook the certification section by the competent tax authorities of the beneficiary's country of residence. This certification is essential for the form's acceptance and processing.

Adhering to these guidelines will not only streamline the process of requesting exemptions based on the double taxation convention but also minimize the chances of errors that could potentially delay or nullify the request. Always double-check the information provided for accuracy before submission.

Misconceptions

Understanding the Mod 21-RFI form can be quite the task for someone unfamiliar with it. This document, a staple in managing taxes for international income in Portugal, often comes with its share of misconceptions. Here, we aim to clarify some of these common misunderstandings to provide a clearer view.

  • It's only for large corporations: Contrary to what many believe, the Mod 21-RFI form isn't exclusively for big multinational companies. Individuals and small businesses dealing with income from Portuguese sources can also use this form to apply for tax exemption or reduction under tax treaties.
  • It covers all types of income: While the form is comprehensive, it's specifically designed for incomes like dividends, interests, royalties, and income from independent personal services, among others. It doesn’t apply to all income types. Knowing which income categories it covers is crucial.
  • Submission is complex and time-consuming: The process might seem daunting, but it's quite straightforward once you understand the requirements. Accurately filling out the necessary information and having the competent tax authorities of your residence country certify it are the main steps.
  • It's valid indefinitely: Another common myth is that once you submit the Mod 21-RFI form, it's valid for an indefinite period. In reality, the form's validity extends up to one year from the date of approval. Hence, it requires annual renewal for ongoing tax exemptions or reductions.
  • Only benefits the Portuguese government: The benefit of this form is mutual. While it ensures that Portugal receives its fair share of taxes, it also protects the taxpayer from double taxation, thereby encouraging foreign investment and economic collaboration.
  • Any tax authority signature will suffice: The certification section of the form needs to be signed specifically by the competent tax authorities of the beneficial owner’s country of residence. Not any signature from the authority will do; it has to come from an authorized official.
  • Filling it out guarantees exemption: Completing the Mod 21-RFI form doesn’t automatically guarantee tax exemption or reduction. The eligibility depends on the specific tax treaty between Portugal and the resident country of the income’s beneficial owner, and the competent Portuguese tax authorities’ assessment.

Clearing up these misconceptions is essential for anyone looking to utilize the Mod 21-RFI form. It ensures that the process is approached with the right expectations and proper understanding of its scope, benefits, and limitations.

Key takeaways

Understanding the Mod 21 form is crucial for anyone looking to claim total or partial exemption from Portuguese withholding tax under a Double Taxation Avoidance Agreement (DTAA). Below are key takeaways to help guide you through the process:

  • The Mod 21 form is designed to request a total or partial exemption from Portuguese withholding tax for income beneficiaries who reside in a country that has a DTAA with Portugal.
  • It's necessary to fill out the form in triplicate: one copy will be retained by the effective beneficiary or their legal representative, one should be sent to the Portuguese tax authorities, and one is for the entity responsible for withholding the tax.
  • The form is valid for one year from the date of its certification by the competent tax authority in the beneficiary's country of residence. Any changes in the circumstances upon which the exemption was granted should be promptly communicated to the paying entity.
  • When manually completing the form, ensure information like the name/business name and address is written clearly in block capitals.
  • Specific details about the nature of the income need to be identified clearly in Section II, depending on the applicable articles of the relevant DTAA.
  • Certification by the competent tax authorities of the beneficiary's state of residence is mandatory in Section III, confirming the beneficiary's fiscal residence and tax liability in accordance with the DTAA terms.
  • Questions in Section IV must be answered with a simple "Yes" or "No," providing additional specifics where applicable. These questions help to further determine eligibility for the withholding tax exemption.
  • If the beneficiary has financial assets in Portugal managed by a non-resident financial intermediary, Section V requires information about this intermediary. This situation commonly arises with investments in Portuguese securities held in non-resident accounts.
  • Correct and complete form submission is paramount. The request for exemption is only considered validly submitted when the form is accurately filled in all respects. Any incomplete or incorrect submission may lead to delays or denial of the exemption request.
  • The declaration in Section VIII, to be signed by the beneficial owner or their legal representative, affirms the accuracy of the information provided in the form and the eligibility for the requested withholding tax exemption.

Accuracy, timeliness, and transparency are key when dealing with tax exemption requests. The successful processing of a Mod 21 form hinges on the precise and full completion of all required sections and duly certified by relevant authorities. When in doubt, seeking professional advice can help navigate the complexities of tax treaties and ensure compliance with all statutory requirements.

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