inland revenue - Steuerliches Info

IT 27
G.P.-S. 026-0964
REPUBLIC OF SOUTH AFRICA
INLAND REVENUE
DEPARTMENT OF FINANCE
APPLICATION FOR REFUND OF OR RELIEF FROM SOUTH AFRICAN TAX IN TERMS OF
THE DOUBLE TAXATION
AVOIDANCE CONVENTION WITH THE FEDERAL REPUBLIC OF GERMANY
Form to be completed in triplicate by a resident of the Federal Republic of Germany who claims a refund of or relief from South African taxes on
income on interest, royalties, pensions, annuities and dividends.
When this form has been completed and signed, TWO copies should be sent to the officer responsible for the assessment
of the claimant to income tax in the Federal Republic of Germany. One of the copies certified correct by the latter authority
should be forwarded by the claimant to the Commissioner for Inland Revenue, P.O. Box 402, Pretoria, 0001.
INFORMATION REQUIRED
REPLY
1. Name and address of claimant:
(a) Name in full, In the case of a company, state full name of company (in
blockletters) ........................................................................................................
_____________________________________
(b) In the case of a married woman, state full name of husband ……………..…….
_____________________________________
(c) Full residential address. In the case of a company, the full address of the
company ……………….………………………………………………………………
_____________________________________
2. If the claimant is a company, where is its business managed and controlled?
_________________________________________
3. On the dates) set out in column (b) referred to overleaf:
(a) Were you beneficially entitled to the income specified on the attached
schedules? …………………………………………………………………………….
(b) Weгe you a resident of the Federal Republic of Germany within the
meaning of article 3 of the Convention?…………………………………………….
(Yes or no) ________________________________
4. During any calendar year ín which the income in question became due:
(a) Were you engaged in trade or business ín South Africa through a permanent
establishment situated therein?……………………………………………………..
(b) Were you a member of a partnership created or organised under South African
Law? …………………………………………………………………………………..
(c) If the claimant ís a company and repayment ís claimed of South Afгican tax
deducted from dividends paid by South African com anies in terms of article 7
(2) (a) of the Convention, did it (the claímant~on the dates) set out in column
(b) of schedule 4 referred to overleaf own directly at least 25 per cent of the
entire voting shares of the companies specified in column (a) of the said
schedule? ………….…………………………………………………………………..
(Yes or no) ________________________________
(Yes or no) ________________________________
(Yes or no) ________________________________
(Yes or no) ________________________________
[If any answer to be given under (a), (b) or (c) above is "Yes", give full particulars]
5. Was the full amount of income listed in the schedules attached hereto [except
where the claim is made under article 7 (2) (a) of the Double Taxation Convention]
subject to tax ín the Federal Republic of Germany? ……………………………………….
(Yes or no) ________________________________
If the answer is "No", give full particulars …………………………………………………………
_________________________________________
DECLARATION TO BE MADE BY CLAIMANT
I do hereby solemnly declare that the particulars given on this form, including particulars given on the attached schedules, are true in every
respect.
I have not filed nor caused to be filed any other claim for refund of South African tax in respect of items of income listed on the schedules and
have no knowledge of any other person or persons having claimed or caused to be claimed a refund of South African tax in respect of such
income.
*I / The company therefore claims) a refund of South African tax amounting to R ____________________as set out on the supporting
schedules. I request that the refund be made:
To me direct †
To the Banker or Agent as named below †
_____________________________________
________________________________________
_____________________________________
Signatur
_____________________________________
* Delete as necessary
† Delete whichever is inapplicable.
Date _______________________________
CLAIM FOR FUTURE RELIEF
If the circumstances stated on this form are unchanged and no change is expected in this or any of the next three calendar years, a claim may
be made to have further payments of the income made under deduction of the appropriate amount of, or without deduction of South African
tax. If you so claim, sign below.
Signature _______________________________________
IT 27
SCHEDULES
Full details (on the lines indicated hereunder) of the income in respect of which relief ís claimed must be furnished on separate schedules.
The schedules must also be completed in triplicate and must be attached to this form.
The appropriate receipts or tax deduction must be attached.
1. ITEREST
(a)
(b)
(c)
(d)
(e)
(f)
(i) Full description
of Assets:
Bonds, Loans,
Bank deposits,
etc.; and (ií) full
name and
address of
person by whom
interest is paid
Due dates)
of interest
(day, month,
year)
Amount (s)
of income
before
deduction
of tax
Amount of
South African
tax
deducted
Number, date
and office
of issue of
receipt issued
in respect of
the South
African Non
Resident Tax
on interest
paid
Refund
claimed
(a)
(b)
(c)
(d)
(e)
(i) Full description of royalties,
date of contract and; (ii) full name and
address of debtor
Due dates) of
income(day,
month, year)
Amounts) of
income before
deduction of tax
Amount of South
Afгican tax
deducted
Refund claimed
(a)
(b)
(c)
(d)
(e)
Full particulars of pensions
and annuities
Due dates) of
income(day,
month, year)
Amounts) of
income before
deduction of tax
Amount of South
Afгican tax
deducted
2. ROYALTIES
3. PENSIONS AND ANNUITIES
Refund claimed
4. DIVIDENDS
(a)
Full description of
stocks in
South Afгican
Company; and (ii)
name and address
of each company
paying the dividends
(b)
(c)
(d)
(e)
(f)
Due dates)
of
dividend
(day, month, year)
Amount of
income before
deduction of tax
South African
tax paid
Number, date
and office of
issue of
receipt issued
in respect of
tax on
dividends
Refund
claimed
CERTIFICATE BY THE TAXATION AUTHORITIES OF THE FEDERAL REPUBLIC OF GERMANY
It is hereby certified that __________________________________________________________________________________________
(name of claimant) was, on the dates) stated in column (b) of the attached scheduled, a resident of the Federal Republic of Germany, within the
meaning of the South Africa-Federal Republic of Germany Double Taxation Avoidance Convention and is, except where the claim is made
under article 7 (2) (a) of the Convention, subject to tax in the Federal Republic of Germany in respect of the income derived from the sources
specified in those schedules.
Official stamp
Signature _____________________________________
Date ____________________________
Designation ___________________________________