意大利专用Statement表.doc

To Consiglio Nazionale delle Ricerche Ufficio Accordi e Relazioni Internazionali Piazzale Aldo Moro, 7 00185 - Roma Subject: Statement - Agreement on scientific cooperation between CNR and CAS (China) Research stay of Dr./Prof. With reference to the above mentioned Agreement the undersigned (first name) …………………………………………………………………….................................................... .. (last name) .......................................................…………………………………………………………… ...…, born in (town, country) ………………………………………………………………………………………………............... on (date) …………………………....., who permanently resides (town, in address) .................................................................... .............................................................................. ..................................................., (please attach a copy of Passport/ID document) Scientific Institution .............................................................................. ................... .............................................................................. ..................................................., declares that he/she will carry out a research stay in Italy at (Italian Host Institute) starting ……………………………………………………………………………………, from (date) ………………………………., of will (duration) …………………………………, receive sum a of Euro ............................... Please tick off as applicable: He/She declares his/her wish to benefit of the Agreement signed between Italy and the Republic of China aiming to avoid double taxation on income and property and to prevent fiscal evasion and therefore to choose to pay taxes on such sum in China (only in this case please attach a authority. copy of the Should CNR certification not receive of Permanent Residence by proper certification, taxation Italy will be executed) He/She declares to choose to pay taxes on such sum in Italy. tax in He/She declares to that he/ she wishes to receive the whole sum due, directly on his /her personal bank account, on completion of the research stay. The undersigned discloses the details of his/her bank account (to be filled only if the sum is higher than 1,000.00 Euro or if he/ she wishes to receive the whole sum due, directly on his /her personal bank account, on completion of the research stay ) IBAN Code/personal bank account code……………………………… Swift Code ………………………………… Date, ..............................