Certificate of Payments and Withholdings to Non-residents

CERTIFICATE OF PAYMENTS AND WITHHOLDINGS TO NON-RESIDENTS
FRONT
2016
PAGE NUMBER
1
__________
PAYMENT PERIOD:
BEGINNING MONTH ________
ENDING MONTH ______
YEAR _______
IDENTIFICATION INFORMATION OF THE NON-RESIDENT
NAME OR NAME OF LEGAL ENTITY OR CORPORATE NAME __________________________________________________________________________________
ADDRESS OF THE NON-RESIDENT (STREET, STREET NUMBER, __ ________________________________________________
POSTAL CODE, CITY, TELEPHONE NUMBER)
TAX IDENTIFICATION NUMBER (see instruction 2) ____ _______________________________________ CODE OF THE COUNTRY OF RESIDENCE _________ __________
(see instruction 3)
2
DESCRIPTION OF PAYMENTS MADE
A. CODE OF THE RECEIVER OF THE INCOME _________________
B. SURNAME(S) AND GIVEN NAME(S) OR
CORPORTE NAME OR NAME OF THE LEGAL ENTITY __
OF THE BENEFICIARY OF THE PAYMENTS
C. CODE OF THE COUNTRY OF RESIDENCE
OF THE EFFECTIVE BENEFICIARYOF THE PAYMENTS _____ _______
(see instruction 5)
D. TAX IDENTIFICATION NUMBER
OF THE EFFECTIVE BENEFICIARY____ ____
OF THE PAYMENTS
E. CODE OF THE
RELATED PARTY___
(see instruction 6)
F. PAYMENT CODE ______________________
(see instruction 7)
K. INCOME TAX WITHHELD _______ _________________
(see instruction 12)
G. SPECIFY ________________________________
(Only when code 40 “Others” is chosen)
L. VALUE-ADDED TAX WITHHELD __________________________
(see instruction 13)
H. AMOUNT OF PAYMENT _________
(see instruction 9)
M. EXEMPTION CODE _____________________________________
I. WITHHOLDING RATE ____________ %
(see instruction 10)
N. PLACE AN “X” IF A TAX RATE PROVIDED ___________________
BY A DOUBLE TAX TREATY WAS USED
(see instruction 14)
J. COST OF THE OPERATION _________________
(see instruction 11)
3
INSTRUCTIONS
1. Except in the spaces where it requests information in
percentages, the values and amounts required in this form
should be expressed in Mexican Pesos (including the
balance of loans), currency conversions should be made in
accordance with the provisions of the Federal Tax Code.
IDENTIFICATION INFORMATION OF THE NON-RESIDENT
2. TAX IDENTIFICATION NUMBER. Note the number or tax
identification code of the non-resident in its country of
residence for the non-resident that had Mexican source
income and where, in case that election is made to generate
the certificate, it will be valid.
3. CODE OF THE COUNTRY OF RESIDENCE. This refers
to the country of residence of the foreign individual or entity
to which payment was made. The country of residence
indicated should not necessarily coincide with the country of
residence of the effective beneficiary of the income. Write the
code of the country of residence in accordance with the list
published on the webpage of the Tax Administration Service
(SAT).
6. CODE OF THE RELATED PARTY. Write the code that
corresponds accordance to the relationship that exists
between the taxpayer and the non-resident that has obtained
Mexican source income in accordance with the following:
A
None.
B
Holding Company. One who has permanent
investments, which are understood to be investments made
in representative titles of the share capital of other entities
with the intention of maintaining those investments for an
undefined period.
C
Controller. One that controls one or more
subsidiaries.
D
Subsidiary. This is the entity that is controlled
by another entity, known as the controller.
E
Associated. This is an entity in which the
holding company has significant influence in its
administration but without having control.
F
Affiliate. Those companies that have common
shareholders or significant common administration.
12
13
14
15
16
17
18
19
20
21
22
23
24
25
7. PAYMENT CODE. Write the code in accordance to the
following:
26
DESCRIPTION OF PAYMENTS MADE
01
4. CODE OF THE RECEIVER OF THE INCOME. Write the
code which corresponds to the following:
01
02
03
04
05
06
07
15
20
Artists, athletes and performers
Other individuals
Entity
Trust
Joint venture
International Organization or Government
Exempt organizations
Paying agents
Others
5. CODE OF THE COUNTRY OF RESIDENCE OF THE
EFFECTIVE BENEFICIARY OF THE PAYMENTS. This
refers to the country of residence of the individual or entity of
the non-resident that is the effective beneficiary of the
income. Write the code of the country of residence in
accordance with the list published on the webpage of the Tax
Administrative Service (SAT).
02
03
04
05
06
07
08
09
10
11
Salaries and wages (except for government
services)
Independent personal services (except fees to
board members and for government services)
Fees to board members
Interest (Art. 195, fraction I income Tax Act
Interest (Art. 195, fraction II Income Tax Act)
Interest (Art. 195, fraction III Income Tax Act)
Interest (Art. 195, fraction IV, Income Tax Act)
Interest (Others)
Dividends paid to entities that are the owners of
more than 10% of the shares representing the
share capital
Dividends paid to other persons
Royalties for the use or temporary enjoyment of
railcars (Art. 200, fraction I Income Tax Act)
27
28
29
30
31
32
40
Royalties (different than the ones in fraction I
except technical assistance of Art. 200, fraction
II Income Tax Act)
Other royalties
Technical assistance (Art. 200 fraction II
Income Tax Act)
Capital gains (alienation of immovable property)
Capital gains (alienation of shares or titles of
value)
Capital gains (others)
Remuneration for government services
(salaries and wages)
Remuneration for government services
(pensions)
Remuneration for government services (others)
Child support
Artists, athletes and performers
Immovable property (agriculture)
Immovable property (royalties for the use of
natural resources)
Immovable property (use or temporary
enjoyment)
Immovable property (destined for
accommodation or lodging)
Immovable property (others)
Construction, installation, maintenance and
assembly
Commissions
Income derived from contracts for time-sharing
tourist services
Income for premiums paid or ceded to
reinsurers
Income for premiums paid or ceded to captive
reinsurers
Others
8. The codes corresponding to the income that the nonresident receives may also be applicable when the
benefits of an international tax treaty are used.
9. AMOUNT OF PAYMENT. Write the gross amount of
the payment to the non-resident that comes from Mexican
sources.
10. Write the whole quantities in the field on the left and
the fractions up to the ten thousandth in the field on the
right without omitting a digit even when the amount is
zero.
Example: Interest rate equal to 8.09 should be written as:
8 . 0900
BACK
2015
4
FOREIGN FINANCING (see instruction 15)
TYPE OF FINANCING ___________
(see instruction 16)
DENOMINATION OF ____________________________
THE BASE RATE (1)
APPLICABLE INTEREST RATE _____ . ________ %
(see instruction 10)
A. DATE OF OPENING OF THE _____ _____ _____
FINANCING OPERATION
(day, month, year)
D. DATE OR FREQUENCY OF CALLABILITY ______________________________
OF THE INTEREST (see instruction 18)
B. DATE OF EXPIRY OR DUE DATE _____ _____ ______
OF FINANCING OPERATION
(day, month, year)
E. PORCENTAGE OF GUARANTEED ________ . ___________ %
FINANCING (see instruction 10)
C. UNPAID BALANCE AS AT 31 DECEMBER ___________________________
OF THE YEAR, OF THE LOANS THAT
HAVE BEEN GRANTED
F. REGISTRY NUMBER OF THE ENTITY ________________________________
G. NAME OF THE ENTITY THAT _____________________________________ _____________________________________________________________________________
GUARANTEED THE CREDIT
H. ADDRESS OF THE ENTITY THAT _______________________________________________________________________________________________________________
GUARANTEED THE CREDIT (Street,
street number, postal code, city, country
telephone number)
I. CODE FOR THE COUNTRY OF RESIDENCE OF ________________________
THE ENTITY THAT GUARANTEED THE CREDIT
K. TOTAL AMOUNT OF ______________________________________________
DEDUCTIBLE INTEREST
J. CODE FOR THE COUNTRY OF TAX RESIDENCE _______________________
OF THE EFFECTIVE BENEFICIARY
L. NUMBER OF OFFICE OF AUTHORIZATION ___________________________
OF THE NATIONAL BANKING AND SECURITIES
COMMISSION OF THE FOREIGN PUBLIC OFFER
OF THE SECURITIES ISSUED IN MEXICO
5
INFORMATION ON THE WITHHOLDER
FEDERAL TAXPAYERS’ IDENTIFICATION NUMBER _______________ ______________
UNIQUE POPULATION REGISTRY CODE _______________________________
PATERNAL SURNAME, MATERNAL SURNAME ________________________________._____________________________________________________________________
AND NAME(S) OR LEGAL ENTITY NAME OR
CORPORATE NAME
LEGAL
REPRESENTATIVE
INFORMATION
FEDERAL TAXPAYERS’ IDENTIFICATION ________________
PATERNAL SURNAME, MATERNAL SURNAME ______ _____________________________________________________
AND NAME(S)
_______________________________________
SIGNATURE OF THE WITHHOLDER
OR LEGAL REPRESENTATIVE
3
UNIQUE POPULATION REGISTRY CODE ______________________
_______________________________________
STAMP OF WITHHOLDER (IF APPLICABLE)
______________________________________________
SIGNATURE OF RECEIPT FOR THE NON-RESIDENT
INSTRUCTIONS (Continued)
11. COST OF THE OPERATION. Write the tax cost of the operation for those transactions
where the tax was remitted on a net basis (alienation of shares and alienation of immovable
property).
12. INCOME TAX WITHHELD. Write the amount of income tax withheld or the income tax
remitted by the legal representative of the non-resident.
13. VALUE-ADDED TAX WITHHELD. Write the amount of VAT that was withheld from the
non-resident which does not have a permanent establishment nor a fixed base.
14. EXEMPTION CODE. Write the exemption code in accordance with the following:
1 Exemption in accordance with the Income Tax Act.
2 The income was not from a source in Mexico, but does come from Mexico.
3 Exempt in accordance with an international tax treaty.
4 Others.
FOREIGN FINANCING
15. This area is compulsory when the field PAYMENT CODE shows code 04, 05, 06, 07 or
08.
16. TYPE OF FINANCING. Write the code that corresponds to the type of financing used in
the operation in accordance with the following:
a. Bank acceptances
b. Letters of credit
c. Bridge loan
d. Direct
e. Asset loan
f. Mortgage
g. Global line of credit
h. Secured loan
i. Protocols
j. Commercial loan
k. Fixed asset loan
l. Revolving loan
m. Syndicated credit
n. Others.
17. REGISTRY NUMBER OF THE ENTITY. Write the corresponding number that in
accordance to the Registry of Banks, Financing Entities, Pension and Retirement Funds and
Foreign Investment Funds, published in the Official Gazette of the Federation.
18. DATE OR FREQUENCY OF CALLABILITY OF THE INTEREST. Write the date
specifying the day, month and year o if applicable, period: monthly, bimonthly, etc.
( 1 ) Example: Libor rate, prime rate, fixed, among others.