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Objava Priloga uz Pravilnik o porezu na dohodak

NN 1/2001 (5.1.2001.), Objava Priloga uz Pravilnik o porezu na dohodak

 

31

Uz Pravilnik o porezu na dohodak objav­ljenom u »Narodnim novinama«, broj 132 od 29. prosinca 2000. godine, greškom nije objav­ljen prilog obrazac-ostali dohodak i prilog obrazac-licence, pa se uz citirani Pravilnik objav­ljuje

PRILOG

OBRAZAC-OSTALI DOHODAK
OBRAZAC-LICENCE
UZ PRAVILNIK O POREZU NA DOHODAK

Uz Pravilnik o porezu na dohodak objav­ljuje se obrazac-ostali dohodak primjerak 1 do 4 i Upute za popu­njava­nje: Ostali dohodak, te obrazac-licence 1 do 4 i Upute za popu­njava­nje: Licence.

Urbroj: 50501-01-7
Zagreb, 4. siječ­nja 2001.

Glavna urednica
»Narodnih novina«
S­nježana Bagić, v. r.

 

OBRAZAC – OSTALI DOHODAK
FORM  – OTHER INCOME

PRIMJERAK 1
- za podnositelja zahtjeva -
COPY 1
- for the claimant -

 

 

R E P U B L I K A  H R V A T S K A

MINISTARSTVO FINANCIJA – POREZNA UPRAVA

THE REPUBLIC OF CROATIA

MINISTRY OF FINANCE – TAX ADMINISTRATION

 

 

 

ZAHTJEV ZA UMANJENJE POREZNE OBVEZE, IZUZIMANJE OD POREZA ILI POVRAT VIŠE PLAĆENOG POREZA NA

NAKNADE ZA DJELATNOST OBAVLJENU U REPUBLICI HRVATSKOJ, PREMA UGOVORU O

IZBJEGAVANJU DVOSTRUKOG OPOREZIVANJA IZMEĐU REPUBLIKE HRVATSKE I ………………………………

("Narodne novine – Međunarodni ugovori", broj: ..…)

APPLICATION FOR TAX RELIEF, TAX EXEMPTION OR TAX REFUND FOR REMUNERATION FOR INDEPENDENT

PERSONAL SERVICES RENDERED IN THE REPUBLIC OF CROATIA UNDER THE AGREEMENT  FOR THE AVOIDANCE

OF DOUBLE TAXATION BETWEEN THE REPUBLIC OF CROATIA AND .........................................

("Official Gazette – International Agreements", number: ..…)

 

 

Podaci iz ovog Zahtjeva potrebni su zbog primjene članka 36. Zakona o porezu na dohodak ("Narodne novine", broj 127/00.) i članka 22. Zakona o porezu na dobit (“Narodna novine”, broj 127/00.) - The data to be given in this application are requested under Article 36 of Income Tax Act ("Official Gazette", number 127/00) and Article 22 of Profit Tax Act ("Official Gazette", number 127/00)

 

 

 

I.      PODACI O ISPLATITELJU– INFORMATION ON THE PAYER:

        Ime i prezime / naziv tvrtke  – Full name / business name: .................................................................................................................

        Pravni oblik – Legal form: ......................................................................................................................................................................

        Broj (JMBG ili matični broj) - Number (identification number / tax number): ..........................................................................................

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

                Ulica i broj – Street and number: ....................................................................................................................................................

                Poštanski broj – Postal code: ...............................................Grad – City: ................................................................................….

                Država – State: ..............................................................................................................................................................................

 

 

II.     PODACI O PODNOSITELJU ZAHTJEVA - primatelju NAKNADE – INFORMATION ON THE CLAIMANT – recipient of the REMUNERATION:

        Ime i prezime / naziv tvrtke – Full name / business name: ...................................... ...........................................................................

        (umjetničko ime, ako ga ima – artistic name, if there is any): ................................................................................................................

        Pravni oblik – Legal form: ......................................................................................................................................................................

        Broj – Number: .......................................................................................................................................................................................

        Prebivalište / sjedište – Address: .......................................................................................................................................…………….

                Ulica i broj – Street and number: ....................................................................................................................................................

                Poštanski broj – Postal code: ................................................Grad – City: ................................................................................….

                Država – State: ..............................................................................................................................................................................

 

        Ime i prezime / naziv zastupnika (ako ga ima) – Name of the representative (if any): ..........................................................................

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

 

III.    VRSTA DJELATNOSTI (umjetničke, književne i druge djelatnosti) – TYPE OF ACTIVITY (for example artistic, literary and other activities): ...................................................................................................................................................…………………………….

 

 

IV.                 TRAJANJE DJELATNOSTI (priredba/e je/su održana/e u razdoblju) – THE DURATION OF THE ACTIVITY (the performance/s  was/were held during the period):             

        Početak – Beginning: .............................................................................................................................................................................

        Završetak – End: ....................................................................................................................................................................................

 

 

V.       PODACI O NAKNADI – INFORMATION ABOUT THE REMUNERATION:

        a)     ukupna naknada – total amount of the remuneration: ...................................................................................................................

        b)     postotak porezno priznatih troškova – the percentage of the deductible costs: ............................................................................

        c)     (a)-(b)=porezna osnovica – (a)-(b)=tax base: ................................................................................................................................

        d)     iznos poreza – the amount of tax: ..................................................................................................................................................

        e)     datum uplate – date of payment: ....................................................................................................................................................

 

VI.   PRILOŽENI DOKUMENTI (broj i naziv) – Documents attached (number and title):...............................................………………..

        ...............................................................................................................................................................................................................

 

 

VII. NAČIN POVRATA VIŠE PLAĆENOG POREZA – procedure of the refund:

        U Republici Hrvatskoj ili u – In the Republic of Croatia or in: .................................................................................................................

        Na broj računa – To the account number: .............................................................................................................................................

        Kod (banka) – With the (bank): ..............................................................................................................................................................

        Otvorenog na ime – Opened in the name of: ........................................................................................................................................

 

 

VIII. IZJAVA PODNOSITELJA ZAHTJEVA – STATEMENT OF THE CLAIMANT:

        Potpisnik jamči da su gore navedeni podaci istiniti te da podnositelj zahtjeva, naveden pod točkom II., ispunjava slijedeće uvjete – The undersigned certifies that the beneficial owner  mentioned under II fulfills the following conditions:

        1.     Stvarni je korisnik gore navedenog dohotka – He is the beneficial owner of the mentioned income,

        2.     Dohodak u smislu navedenog Ugovora o izbjegavanju dvostrukog oporezivanja nije ostvaren kroz djelatnost registriranu u Republici Hrvatskoj – He did not derive income, as defined in the mentioned Agreement for the avoidance of double taxation, through the activity registered in the Republic of Croatia,

        3.     Svi su prihodi od priredbe / niza priredaba ili sličnih poslova u cijelosti prijavljeni – The total amount of all of the items of income from the performance / number of performances is declared.

        Poznato mi je da Porezna uprava Republike Hrvatske može poreznom tijelu u državi rezidentnosti podnositelja zahtjeva davati podatke o sadržaju ovog zahtjeva – I am aware of the fact that the Croatian Tax Administration can disclose the information given in this Application to the tax authorities in the country of residence of the claimant.

 

                ....................................................                                                                            ..........................................

                Mjesto i datum – Place and  date                                                                                   Potpis - Signature

 

 

IX.    POTVRDA POREZNOG TIJELA DRŽAVE REZIDENTNOSTI PODNOSITELJA ZAHTJEVA – CERTIFICATE OF TAX AUTHORITY OF CLAIMANT´S COUNTRY OF RESIDENCE:

Podnositelj zahtjeva je rezident .................................. prema članku ............... Ugovora o izbjegavanju dvostrukog oporezivanja između Republike Hrvatske i .................................... – The claimant is the resident of ................................... under Article .......... of the Agreement for the avoidance of double taxation between the Republic of Croatia and ....................................

       

 

 

        ....................................................                    .....................................................                           ....................................................

        Mjesto i datum  - Place and date                                     Pečat - Stamp                                                     Potpis - Signature

       

 

            


PRIMJERAK 2
- za isplatitelja dohotka -
COPY 2
- for the payer of the income -

 

 

R E P U B L I K A  H R V A T S K A

MINISTARSTVO FINANCIJA – POREZNA UPRAVA

THE REPUBLIC OF CROATIA

MINISTRY OF FINANCE – TAX ADMINISTRATION

 

 

 

ZAHTJEV ZA UMANJENJE POREZNE OBVEZE, IZUZIMANJE OD POREZA ILI POVRAT VIŠE PLAĆENOG POREZA NA

NAKNADE ZA DJELATNOST OBAVLJENU U REPUBLICI HRVATSKOJ, PREMA UGOVORU O

IZBJEGAVANJU DVOSTRUKOG OPOREZIVANJA IZMEĐU REPUBLIKE HRVATSKE I ………………………………

("Narodne novine – Međunarodni ugovori", broj: ..…)

APPLICATION FOR TAX RELIEF, TAX EXEMPTION OR TAX REFUND FOR REMUNERATION FOR INDEPENDENT

PERSONAL SERVICES RENDERED IN THE REPUBLIC OF CROATIA UNDER THE AGREEMENT  FOR THE AVOIDANCE

OF DOUBLE TAXATION BETWEEN THE REPUBLIC OF CROATIA AND .........................................

("Official Gazette – International Agreements", number: ..…)

 

 

Podaci iz ovog Zahtjeva potrebni su zbog primjene članka 36. Zakona o porezu na dohodak ("Narodne novine", broj 127/00.) i članka 22. Zakona o porezu na dobit (“Narodna novine”, broj 127/00.) - The data to be given in this application are requested under Article 36 of Income Tax Act ("Official Gazette", number 127/00) and Article 22 of Profit Tax Act ("Official Gazette", number 127/00)

 

 

 

I.      PODACI O ISPLATITELJU– INFORMATION ON THE PAYER:

        Ime i prezime / naziv tvrtke– Full name / business name: ....................................................................................................................

        Pravni oblik – Legal form: ......................................................................................................................................................................

        Broj (JMBG ili matični broj) - Number (identification number / tax number): ..........................................................................................

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

                Ulica i broj – Street and number: ....................................................................................................................................................

                Poštanski broj – Postal code: ......................................Grad – City: ..................................................................................

                Država – State: ..............................................................................................................................................................................

 

 

II.     PODACI O PODNOSITELJU ZAHTJEVA - primatelju NAKNADE – INFORMATION ON THE CLAIMANT – recipient of the REMUNERATION:

        Ime i prezime / naziv tvrtke – Full name / business name: ............................................... ....................................................................

        (umjetničko ime, ako ga ima – artistic name, if there is any): ................................................................................................................

        Pravni oblik – Legal form: ......................................................................................................................................................................

        Broj – Number: .......................................................................................................................................................................................

        Prebivalište / sjedište – Address: ..........................................................................................................................................................

                Ulica i broj – Street and number: ....................................................................................................................................................

                Poštanski broj – Postal code: ................................................Grad – City: ................................................................................….

                Država – State: ..............................................................................................................................................................................

 

        Ime i prezime / naziv zastupnika (ako ga ima) – Name of the representative (if any): ..........................................................................

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

 

III.    VRSTA DJELATNOSTI (umjetničke, književne i druge djelatnosti) – TYPE OF ACTIVITY ( for example artistic, literary and other activities): ......................................................................................................................................................

 

 

IV.                 TRAJANJE DJELATNOSTI (priredba/e je/su održana/e u razdoblju) – THE DURATION OF THE ACTIVITY (the performance/s  was/were held during the period):      

        Početak – Beginning: .............................................................................................................................................................................

        Završetak – End: ....................................................................................................................................................................................

 

 

V.       PODACI O NAKNADI – INFORMATION ABOUT THE REMUNERATION:

        a)     ukupna naknada – total amount of the remuneration: ...................................................................................................................

        b)     postotak porezno priznatih troškova – the percentage of the deductible costs: ............................................................................

        c)     (a)-(b)=porezna osnovica – (a)-(b)=tax base: ................................................................................................................................

        d)     iznos poreza – the amount of tax: ..................................................................................................................................................

        e)     datum uplate – date of payment: ....................................................................................................................................................

 

VI.   PRILOŽENI DOKUMENTI (broj i naziv) – Documents attached (number and title):......................................................................

        ...............................................................................................................................................................................................................

 

 

VII. NAČIN POVRATA VIŠE PLAĆENOG POREZA – procedure of the refund:

        U Republici Hrvatskoj ili u – In the Republic of Croatia or in: .................................................................................................................

        Na broj računa –To the account number: ...............................................................................................

        Kod (banka) – With the (bank): ..............................................................................................................................................................

        Otvorenog  na ime – Opened in the name of: .......................................................................................................................................

 

 

VIII. IZJAVA PODNOSITELJA ZAHTJEVA – STATEMENT OF THE CLAIMANT:

        Potpisnik jamči da su gore navedeni podaci istiniti te da podnositelj zahtjeva, naveden pod točkom II., ispunjava slijedeće uvjete – The undersigned certifies that the beneficial owner  mentioned under II fulfills the following conditions:

        1.     Stvarni je korisnik gore navedenog dohotka – He is the beneficial owner of the mentioned income,

        2.     Dohodak u smislu navedenog Ugovora o izbjegavanju dvostrukog oporezivanja nije ostvaren kroz djelatnost registriranu u Republici Hrvatskoj – He did not derive income, as defined in the mentioned Agreement for the avoidance of  double taxation, through the activity registered in the Republic of Croatia,

        3.     Svi su prihodi od priredbe / niza priredaba ili sličnih poslova u cijelosti prijavljeni – The total amount of all of the items of income from the performance / number of performances is declared.

        Poznato mi je da Porezna uprava Republike Hrvatske može poreznom tijelu u državi rezidentnosti podnositelja zahtjeva davati podatke o sadržaju ovog zahtjeva – I am aware of the fact that the Croatian Tax Administration can disclose the information given in this Application to the tax authorities in the country of residence of the claimant.

 

                ....................................................                                                                            ..........................................

                Mjesto i datum – Place and date                                                                                    Potpis - Signature

 

 

IX.    POTVRDA POREZNOG TIJELA DRŽAVE REZIDENTNOSTI PODNOSITELJA ZAHTJEVA – CERTIFICATE OF TAX AUTHORITY OF CLAIMANT´S COUNTRY OF RESIDENCE:

Podnositelj zahtjeva je rezident .................................. prema članku ............... Ugovora o izbjegavanju dvostrukog oporezivanja između Republike Hrvatske i .................................... – The claimant is the resident of ................................... under Article .......... of the Agreement for the avoidance of double taxation between the Republic of Croatia and ....................................

       

 

 

        ....................................................                    .....................................................                           ....................................................

        Mjesto i datum  - Place and date                                     Pečat - Stamp                                                     Potpis - Signature


 

 

PRIMJERAK 3
- za Poreznu upravu Republike Hrvatske -
COPY 3
- for the Tax Administration of the Republic of Croatia -

 

 

R E P U B L I K A  H R V A T S K A

MINISTARSTVO FINANCIJA – POREZNA UPRAVA

THE REPUBLIC OF CROATIA

MINISTRY OF FINANCE – TAX ADMINISTRATION

 

 

 

ZAHTJEV ZA UMANJENJE POREZNE OBVEZE, IZUZIMANJE OD POREZA ILI POVRAT VIŠE PLAĆENOG POREZA NA

NAKNADE ZA DJELATNOST OBAVLJENU U REPUBLICI HRVATSKOJ, PREMA UGOVORU O

IZBJEGAVANJU DVOSTRUKOG OPOREZIVANJA IZMEĐU REPUBLIKE HRVATSKE I ………………………………

("Narodne novine – Međunarodni ugovori", broj: ..…)

APPLICATION FOR TAX RELIEF, TAX EXEMPTION OR TAX REFUND FOR REMUNERATION FOR INDEPENDENT

PERSONAL SERVICES RENDERED IN THE REPUBLIC OF CROATIA UNDER THE AGREEMENT  FOR THE AVOIDANCE

OF DOUBLE TAXATION BETWEEN THE REPUBLIC OF CROATIA AND .........................................

("Official Gazette – International Agreements", number: ..…)

 

 

Podaci iz ovog Zahtjeva potrebni su zbog primjene članka 36. Zakona o porezu na dohodak ("Narodne novine", broj 127/00.) i članka 22. Zakona o porezu na dobit (“Narodna novine”, broj 127/00.) - The data to be given in this application are requested under Article 36 of Income Tax Act ("Official Gazette", number 127/00) and Article 22 of Profit Tax Act ("Official Gazette", number 127/00)

 

 

 

I.      PODACI O ISPLATITELJU– INFORMATION ON THE PAYER:

        Ime i prezime / naziv tvrtke – Full name / business name: ....................................................................................................................

        Pravni oblik – Legal form: ......................................................................................................................................................................

        Broj (JMBG ili matični broj) - Number (identification number / tax number): ..........................................................................................

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

                Ulica i broj – Street and number: ....................................................................................................................................................

                Poštanski broj – Postal code: ...............................................Grad – City: ................................................................................…..

                Država – State: ..............................................................................................................................................................................

 

 

II.     PODACI O PODNOSITELJU ZAHTJEVA - primatelju NAKNADE – INFORMATION ON THE CLAIMANT – recipient of the REMUNERATION:

        Ime i prezime / naziv tvrtke – Full name / business name: ............................................... ....................................................................

        (umjetničko ime, ako ga ima – artistic name, if there is any): ................................................................................................................

        Pravni oblik – Legal form: ......................................................................................................................................................................

        Broj – Number: .......................................................................................................................................................................................

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

                Ulica i broj – Street and number: ....................................................................................................................................................

                Poštanski broj – Postal code: ..................................................Grad – City: ..................................................................................

                Država – State: ..............................................................................................................................................................................

 

        Ime i prezime / naziv zastupnika (ako ga ima) – Name of the representative (if any): ..........................................................................

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

 

III.    VRSTA DJELATNOSTI (umjetničke, književne i druge djelatnosti) – TYPE OF ACTIVITY (for example artistic, literary and other activities): ...........................................................................................................................................................................................

 

 

IV.                 TRAJANJE DJELATNOSTI (priredba/e je/su održana/e u razdoblju) – THE DURATION OF THE ACTIVITY (the performance/s  was/were held during the period):      

        Početak – Beginning: .............................................................................................................................................................................

        Završetak – End: ....................................................................................................................................................................................

 

 

V.       PODACI O NAKNADI – INFORMATION ABOUT THE REMUNERATION:

        a)     ukupna naknada – total amount of the remuneration: ...................................................................................................................

        b)     postotak porezno priznatih troškova – the percentage of the deductible costs: ............................................................................

        c)     (a)-(b)=porezna osnovica – (a)-(b)=tax base: ................................................................................................................................

        d)     iznos poreza – the amount of tax: ..................................................................................................................................................

        e)     datum uplate – date of payment: ....................................................................................................................................................

 

VI.   PRILOŽENI DOKUMENTI (broj i naziv) – Documents attached (number and title):......................................................................

        ...............................................................................................................................................................................................................

 

 

VII. NAČIN POVRATA VIŠE PLAĆENOG POREZA – procedure of the refund:

        U Republici Hrvatskoj ili u – In the Republic of Croatia or in: .................................................................................................................

        Na broj računa – To the account number: ...................................................................................................................................……..

        Kod (banka) – With the (bank): ..............................................................................................................................................................

        Otvorenog na ime – Opened in the name of: ........................................................................................................................................

 

 

VIII. IZJAVA PODNOSITELJA ZAHTJEVA – STATEMENT OF THE CLAIMANT:

        Potpisnik jamči da su gore navedeni podaci istiniti te da podnositelj zahtjeva, naveden pod točkom II., ispunjava slijedeće uvjete – The undersigned certifies that the beneficial owner  mentioned under II fulfills the following conditions:

        1.     Stvarni je korisnik gore navedenog dohotka – He is the beneficial owner of the mentioned income,

        2.     Dohodak u smislu navedenog Ugovora o izbjegavanju dvostrukog oporezivanja nije ostvaren kroz djelatnost registriranu u Republici Hrvatskoj – He did not derive income, as defined in the mentioned Agreement for the avoidance of  double taxation, through the activity registered in the Republic of Croatia,

        3.     Svi su prihodi od priredbe / niza priredaba ili sličnih poslova u cijelosti prijavljeni – The total amount of all of the items of income from the performance / number of performances is declared.

        Poznato mi je da Porezna uprava Republike Hrvatske može poreznom tijelu u državi rezidentnosti podnositelja zahtjeva davati podatke o sadržaju ovog zahtjeva – I am aware of the fact that the Croatian Tax Administration can disclose the information given in this Application to the tax authorities in the country of residence of the claimant.

 

                ....................................................                                                                            ..........................................

                Mjesto i datum – Place and date                                                                                    Potpis - Signature

 

 

IX.    POTVRDA POREZNOG TIJELA DRŽAVE REZIDENTNOSTI PODNOSITELJA ZAHTJEVA – CERTIFICATE OF TAX AUTHORITY OF CLAIMANT´S COUNTRY OF RESIDENCE:

Podnositelj zahtjeva je rezident .................................. prema članku ............... Ugovora o izbjegavanju dvostrukog oporezivanja između Republike Hrvatske i .................................... – The claimant is the resident of ................................... under Article .......... of the Agreement for the avoidance of double taxation between the Republic of Croatia and ....................................

       

 

 

        ....................................................                    .....................................................                           ....................................................

        Mjesto i datum  - Place and date                                     Pečat - Stamp                                                     Potpis - Signature

 

 

VIII. NAPOMENE POREZNE UPRAVE REPUBLIKE HRVATSKE (ako ih ima) – CROATIAN TAX AUTHORITIES REMARKS (if any)

 

 

 

 

PRIMJERAK 4
- za inozemno porezno tijelo -
COPY 4
- for the foreign tax authotity -

 

 

R E P U B L I K A  H R V A T S K A

MINISTARSTVO FINANCIJA – POREZNA UPRAVA

THE REPUBLIC OF CROATIA

MINISTRY OF FINANCE – TAX ADMINISTRATION

 

 

 

ZAHTJEV ZA UMANJENJE POREZNE OBVEZE, IZUZIMANJE OD POREZA ILI POVRAT VIŠE PLAĆENOG POREZA NA

NAKNADE ZA DJELATNOST OBAVLJENU U REPUBLICI HRVATSKOJ, PREMA UGOVORU O

IZBJEGAVANJU DVOSTRUKOG OPOREZIVANJA IZMEĐU REPUBLIKE HRVATSKE I ………………………………

("Narodne novine – Međunarodni ugovori", broj: ..…)

APPLICATION FOR TAX RELIEF, TAX EXEMPTION OR TAX REFUND FOR REMUNERATION FOR INDEPENDENT

PERSONAL SERVICES RENDERED IN THE REPUBLIC OF CROATIA UNDER THE AGREEMENT  FOR THE AVOIDANCE

OF DOUBLE TAXATION BETWEEN THE REPUBLIC OF CROATIA AND .........................................

("Official Gazette – International Agreements", number: ..…)

 

 

Podaci iz ovog Zahtjeva potrebni su zbog primjene članka 36. Zakona o porezu na dohodak ("Narodne novine", broj 127/00.) i članka 22. Zakona o porezu na dobit (“Narodna novine”, broj 127/00.) - The data to be given in this application are requested under Article 36 of Income Tax Act ("Official Gazette", number 127/00) and Article 22 of Profit Tax Act ("Official Gazette", number 127/00)

 

 

 

I.      PODACI O ISPLATITELJU– INFORMATION ON THE PAYER:

        Ime i prezime / naziv tvrtke  – Full name / business name: ..................................................................................................................

        Pravni oblik – Legal form: ......................................................................................................................................................................

        Broj (JMBG ili matični broj) - Number (identification number / tax number): ..........................................................................................

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

                Ulica i broj – Street and number: ....................................................................................................................................................

                Poštanski broj – Postal code: ..................................................Grad – City: ..................................................................................

                Država – State: ..............................................................................................................................................................................

 

 

II.     PODACI O PODNOSITELJU ZAHTJEVA - primatelju NAKNADE – INFORMATION ON THE CLAIMANT – recipient of the REMUNERATION:

        Ime i prezime / naziv tvrtke – Full name / business name: ............................................... ..................................................................

        (umjetničko ime, ako ga ima – artistic name, if there is any): ................................................................................................................

        Pravni oblik – Legal form: ......................................................................................................................................................................

        Broj – Number: .......................................................................................................................................................................................

        Prebivalište – Address: .....................................................................................................................................................................

                Ulica i broj – Street and number: ....................................................................................................................................................

                Poštanski broj – Postal code: ...............................................Grad – City: ..................................................................................

                Država – State: ..............................................................................................................................................................................

 

        Ime i prezime / naziv zastupnika (ako ga ima) – Name of the representative (if any): ..........................................................................

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

 

III.    VRSTA DJELATNOSTI (umjetničke, književne i druge djelatnosti) – TYPE OF ACTIVITY (for example artistic, literary and other activities): .............................................................................................................................................

 

 

IV.                 TRAJANJE DJELATNOSTI (priredba/e je/su održana/e u razdoblju) – THE DURATION OF THE ACTIVITY (the performance/s  was/were held during the period):      

        Početak – Beginning: .............................................................................................................................................................................

        Završetak – End: ....................................................................................................................................................................................

 

 

V.       PODACI O NAKNADI – INFORMATION ABOUT THE REMUNERATION:

        a)     ukupna naknada – total amount of the remuneration: ...................................................................................................................

        b)     postotak porezno priznatih troškova – the percentage of the deductible costs: ............................................................................

        c)     (a)-(b)=porezna osnovica – (a)-(b)=tax base: ................................................................................................................................

        d)     iznos poreza – the amount of tax: ..................................................................................................................................................

        e)     datum uplate – date of payment: ....................................................................................................................................................

 

VI.   PRILOŽENI DOKUMENTI (broj i naziv) – Documents attached (number and title):......................................................................

        ...............................................................................................................................................................................................................

 

 

VII. NAČIN POVRATA VIŠE PLAĆENOG POREZA – procedure of the refund:

        U Republici Hrvatskoj ili u – In the Republic of Croatia or in: .................................................................................................................

        Na broj računa –To the account number: ...............................................................................................................................

        Kod (banka) – With the (bank): ..............................................................................................................................................................

        Otvorenog na ime – Opened in the name of: ........................................................................................................................................

 

 

VIII. IZJAVA PODNOSITELJA ZAHTJEVA – STATEMENT OF THE CLAIMANT:

        Potpisnik jamči da su gore navedeni podaci istiniti te da podnositelj zahtjeva, naveden pod točkom II., ispunjava slijedeće uvjete – The undersigned certifies that the beneficial owner  mentioned under II fulfills the following conditions:

        1.     Stvarni je korisnik gore navedenog dohotka – He is the beneficial owner of the mentioned income,

        2.     Dohodak u smislu navedenog Ugovora o izbjegavanju dvostrukog oporezivanja nije ostvaren kroz djelatnost registriranu u Republici Hrvatskoj – He did not derive income, as defined in the mentioned Agreement for the avoidance of double taxation, through the activity registered in the Republic of Croatia,

        3.     Svi su prihodi od priredbe / niza priredaba ili sličnih poslova u cijelosti prijavljeni – The total amount of all of the items of income from the performance / number of performances is declared.

        Poznato mi je da Porezna uprava Republike Hrvatske može poreznom tijelu u državi rezidentnosti podnositelja zahtjeva davati podatke o sadržaju ovog zahtjeva – I am aware of the fact that the Croatian Tax Administration can disclose the information given in this Application to the tax authorities in the country of residence of the claimant.

 

                ....................................................                                                                            ..........................................

                Mjesto i datum – Place and date                                                                                    Potpis - Signature

 

 

IX.    POTVRDA POREZNOG TIJELA DRŽAVE REZIDENTNOSTI PODNOSITELJA ZAHTJEVA – CERTIFICATE OF TAX AUTHORITY OF CLAIMANT´S COUNTRY OF RESIDENCE:

Podnositelj zahtjeva je rezident .................................. prema članku ............... Ugovora o izbjegavanju dvostrukog oporezivanja između Republike Hrvatske i .................................... – The claimant is the resident of ................................... under Article .......... of the Agreement for the avoidance of double taxation between the Republic of Croatia and ....................................

       

 

 

        ....................................................                    .....................................................                           ....................................................

        Mjesto i datum  - Place and date                                     Pečat - Stamp                                                     Potpis - Signature

 

 

UPUTA ZA POPUNJAVANJE: OSTALI DOHODAK

 

1.      Ovaj obrazac podnosi se radi umanjenja porezne obveze, izuzimanja od poreza ili povrata više plaćenog poreza za naknadu za obavljenu djelatnost osobi koja ima prebivalište, uobičajeno boravište ili sjedište (rezidentu) u državi s kojom je Republika Hrvatska sklopila Ugovor o izbjegavanju dvostrukog oporezivanja.

 

2.      Obrazac se sastoji od četiri primjerka. Prvi je primjerak za podnositelja zahtjeva, drugi za isplatitelja, treći za Poreznu upravu Ministarstva financija Republike Hrvatske, a četvrti za inozemno porezno tijelo. Točke II, VI, VII i VIII popunjava podnositelj zahtjeva, točke I, III, IV i V popunjava isplatitelj, a točku IX popunjava inozemno porezno tijelo. Popunjeni i potpisani primjerci obrasca predaju se inozemnim poreznim tijelima zemlje koje je primatelj rezident. Inozemna porezna tijela će provesti potrebnu kontrolu, ovjeriti predočeni obrazac i zadržati svoj primjerak, a podnositelju zahtjeva vratiti preostala tri primjerka (za podnositelja zahtjeva, isplatitelja i Poreznu upravu Ministarstva financija Republike Hrvatske).

 

3.      Za svakog isplatitelja i za svaku isplatu podnosi se poseban zahtjev.

 

4.      Zahtjev za umanjenje porezne obveze, izuzimanje od poreza ili povrat više plaćenog poreza podnosi se Ministarstvu financija Republike Hrvatske, Poreznoj upravi, Područnom uredu Zagreb, Avenija Dubrovnik 32, najkasnije u roku od tri godine od isteka kalendarske godine u kojoj je isplata izvršena.

 

INSTRUCTIONS FOR FILLING IN THE FORM: OTHER INCOME

 

1.      This form is submitted for tax relief, tax exemption or tax refund for remuneration to a resident of the country with which the Republic of Croatia entered into Agreement for the Avoidance of Double Taxation.

 

2.      The form consists of four copies. The first copy is for the claimant, the second for the payer of the income, the third copy for the Tax Administration of the Republic of Croatia, and the forth copy for the foreign tax authority. Items II, VI, VII , and VIII are to be filled in by the claimant, items I, III, IV and V by the payer of the income, and the item IX by the foreign tax authority. The filled in and signed copies of the form are submitted to the tax authorities of the country in which the recipient is resident. Foreign tax authorities shall carry out the required control, certify a submitted form, and retain their own copy, and return the three remaining copies to the claimant (for the claimant, payer of the income, and the Tax Administration of the Republic of Croatia).

 

3.      For each payer and for each payment a separate claim is made.

 

4.      Application for tax relief, tax exemption or tax refund is submitted to the Ministry of finance of the Republic of Croatia, Tax Administration, Zagreb office, Avenija Dubrovnik 32, at latest within 3 years as of expiry of the calendar year in which the payment is effected.

 

 

 

 

 

 

OBRAZAC-LICENCE
FORM - ROYALTIES

PRIMJERAK 1

- za podnositelja zahtjeva-

COPY 1

- for the claimant -

 

R E P U B L I K A  H R V A T S K A

MINISTARSTVO FINANCIJA – POREZNA UPRAVA

THE REPUBLIC OF CROATIA

MINISTRY OF FINANCE – TAX ADMINISTRATION

 

 

 

ZAHTJEV ZA UMANJENJE POREZNE OBVEZE, IZUZIMANJE OD POREZA ILI POVRAT VIŠE PLAĆENOG POREZA

NA LICENCE I SLIČNA DAVANJA PREMA UGOVORU O IZBJEGAVANJU DVOSTRUKOG OPOREZIVANJA IZMEĐU

REPUBLIKE HRVATSKE I ………………………………

("Narodne novine – Međunarodni ugovori", broj: ..…)

APPLICATION FOR TAX RELIEF, TAX EXEMPTION OR TAX REFUND FOR ROYALTIES UNDER

THE AGREEMENT  FOR THE AVOIDANCE OF DOUBLE TAXATION BETWEEN

THE REPUBLIC OF CROATIA AND .........................................

("Official Gazette – International Agreements", number: ..…)

 

 

Podaci iz ovog Zahtjeva potrebni su zbog primjene članka 23. Zakona o porezu na dohodak ("Narodne novine", broj 127/00.) i članka 22. Zakona o porezu na dobit ("Narodne novine", broj 127/00.) – The data to be given in this application are requested under Article 23 of Income Tax Act ("Official Gazette", number 127/00) and Article 22 of Profit Tax Act ("Official Gazette", number 127/00)

 

 

 

I.              PODACI O StjecateljU licence – INFORMATION ON THE LICENSEE:

        Ime i prezime / naziv tvrtke – Full name / business name: ....................................................................................................................

        Pravni oblik - Legal form: .......................................................................................................................................................................

        Broj (JMBG ili matični broj) - Number (identification number / tax number): ..........................................................................................

        Zanimanje / djelatnost – Occupation: .....................................................................................................................................................

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

                Ulica i broj – Street and number: ....................................................................................................................................................

                Poštanski broj – Postal code: …………………………………….Grad – City: .............…………………………………………………

                Država – State: ...............................................................................................................................................................................

 

 

II.     PODACI O PODNOSITELJU ZAHTJEVA - DavateljU licence – INFORMATION ON THE CLAIMANT – LICENSor:

        Ime i prezime / naziv tvrtke – Full name / business name: ....................................................................................................................

        Pravni oblik - Legal form: .......................................................................................................................................................................

        Broj – Number: .......................................................................................................................................................................................

        Zanimanje / djelatnost – Occupation:

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

                Ulica i broj – Street and number: ....................................................................................................................................................

                Poštanski broj – Postal code: ......................................Grad – City: ................................................................................…………

                Država – State: ...............................................................................................................................................................................

 

        Ime i prezime / naziv zastupnika (ako ga ima) – Name of the representative (if any): ..........................................................................

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

 

 

 

III.    Predmet ugovora o licenci – SUBJECT MATTER OF LICENCE:

 

3.1. Prava intelektualnog vlasništva – Intellectual property rights

3.1.1. Vrste prava intelektualnog vlasništva – Form of intellectual property right:

                ........................................................................................................................................................................................................

                ........................................................................................................................................................................................................

3.1.2. Registracija prava intelektualnog vlasništva – Registration of intellectual property right:

                Država registracije – Country of registration: .................................................................................................................................

                Broj registracije – Registration number: .........................................................................................................................................

Datum registracije – Date of registration: .......................................................................................................................................

        3.1.3. Nositelj prava intelektualnog vlasništva prema registru – Registered owner  of intellectual property  right:

                Ime i prezime / naziv tvrtke – Full name / business name: ............................................................................................................

                Pravni oblik - Legal form: ...............................................................................................................................................................

                Zanimanje / djelatnost – Occupation: .............................................................................................................................................

                Prebivalište / sjedište – Address: ...................................................................................................................................................

                        Ulica i broj – Street and number: ...........................................................................................................................................

                        Poštanski broj – Postal code: .................................... Grad – City: ..........................................................................……….

                        Država – State: .....................................................................................................................................................................

        3.2. Prava na korištenje pokretnina (između ostalog leasing-ugovori) – Right to use movable property (under a leasing or  another agreement)

3.2.1. Vrste pokretnina – Type of movable property:.............................................................................................................................

                ........................................................................................................................................................................................................

3.3 Autorska prava (prava koja ne spadaju pod točku 3.1) – Copyrights (other than those under paragraph 3.1)

3.3.1. Vrste autorskog prava – Form of copyright: .................................................................................................................................

3.3.2. Naziv zaštićenog djela – Title of protected work: ........................................................................................................................

3.3.3. Autor - Author

        Ime – Name: ...................................................................................................................................................................................

Prezime – Surname: .......................................................................................................................................................................

                Prebivalište / sjedište – Address:

                        Ulica i broj – Street and number: ...........................................................................................................................................

                        Poštanski broj – Postal code: ..........................................Grad – City: ..........................................................................……

                        Država – State: .....................................................................................................................................................................

3.3.4. Davatelj licence ovlašten je za davanje licence na temelju – The licensor is authorized to grant licence by virtue of:

..............................................................................................................................................................................................................

 

 

IV.   PODACI O DOHOTKU – DESCRIPTION OF THE INCOME:

        Ukupan iznos dohotka– Total amount of income: ..................................................................................................................................

        Datum isplate – Date of payment: ..........................................................................................................................................................

        Ukupan iznos poreza – Total amount of tax:  ........................................................................................................................................

 

 

V.    PRILOŽENI DOKUMENTI (broj i naziv) – Documents attached (number and title):...................................

        ...............................................................................................................................................................................................................

 

VI.   NAČIN POVRATA VIŠE PLAĆENOG POREZA – procedure of the refund:

        U Republici Hrvatskoj ili u – In the Republic of Croatia or in: .................................................................................................................

        Na broj računa – To the account number: .............................................................................................................................................

        Kod (banka) – With the (Bank): ............................................................................................................................................................

        Otvorenog na ime – Opened in the name of: ........................................................................................................................................

 

VII.  IZJAVA PODNOSITELJA ZAHTJEVA – STATEMENT OF THE CLAIMANT:

        Potpisnik jamči da su gore navedeni podaci istiniti te da podnositelj zahtjeva, naveden pod točkom II., ispunjava slijedeće uvjete – The undersigned certifies that the beneficial owner  mentioned under II fulfills the following conditions:

        1.     Stvarni je korisnik gore navedenog dohotka – He is the beneficial owner of the mentioned income,

        2.     Dohodak u smislu navedenog Ugovora o izbjegavanju dvostrukog oporezivanja nije ostvaren kroz djelatnost registriranu u Republici Hrvatskoj – He did not derive income, as defined in the mentioned Agreement for the avoidance of  double taxation, through the activity registered in the Republic of Croatia,

        Poznato mi je da Porezna uprava Republike Hrvatske može poreznom tijelu u državi rezidentnosti podnositelja zahtjeva davati podatke o sadržaju ovog zahtjeva – I am aware of the fact that the Croatian Tax Administration can disclose the information given in this Application to the tax authorities in the country of residence of the claimant.

 

                ....................................................                                                                            ..........................................

                Mjesto i datum – Place and date                                                                                    Potpis - Signature

 

VIII. POTVRDA POREZNOG TIJELA DRŽAVE REZIDENTNOSTI PODNOSITELJA ZAHTJEVA – CERTIFICATE OF TAX AUTHORITY OF CLAIMANT´S COUNTRY OF RESIDENCE:

        Podnositelj zahtjeva je rezident .................................. prema članku ............... Ugovora o izbjegavanju dvostrukog oporezivanja između Republike Hrvatske i .................................... – The claimant is the resident of ................................... under Article .......... of the Agreement for the avoidance of double taxation between the Republic of Croatia and ....................................

       

 

 

        ....................................................                    .....................................................                           ....................................................

        Mjesto i datum  - Place and date                                     Pečat - Stamp                                                     Potpis - Signature

     

 

PRIMJERAK 2

- za isplatitelja dohotka -

COPY 2

- for the payer of the income -

R E P U B L I K A  H R V A T S K A

MINISTARSTVO FINANCIJA – POREZNA UPRAVA

THE REPUBLIC OF CROATIA

MINISTRY OF FINANCE – TAX ADMINISTRATION

 

 

 

ZAHTJEV ZA UMANJENJE POREZNE OBVEZE, IZUZIMANJE OD POREZA ILI POVRAT VIŠE PLAĆENOG POREZA

NA LICENCE I SLIČNA DAVANJA PREMA UGOVORU O IZBJEGAVANJU DVOSTRUKOG OPOREZIVANJA IZMEĐU

REPUBLIKE HRVATSKE I ………………………………

("Narodne novine – Međunarodni ugovori", broj: ..…)

APPLICATION FOR TAX RELIEF, TAX EXEMPTION OR TAX REFUND FOR ROYALTIES UNDER

THE AGREEMENT  FOR THE AVOIDANCE OF DOUBLE TAXATION BETWEEN

THE REPUBLIC OF CROATIA AND .........................................

("Official Gazette – International Agreements", number: ..…)

 

 

Podaci iz ovog Zahtjeva potrebni su zbog primjene članka 23. Zakona o porezu na dohodak ("Narodne novine", broj 127/00.) i članka 22. Zakona o porezu na dobit ("Narodne novine", broj 127/00.) – The data to be given in this application are requested under Article 23 of Income Tax Act ("Official Gazette", number 127/00) and Article 22 of Profit Tax Act ("Official Gazette", number 127/00)

 

 

 

I.              PODACI O StjecateljU licence – INFORMATION ON THE LICENSEE:

        Ime i prezime / naziv tvrtke – Full name / business name: ....................................................................................................................

        Pravni oblik - Legal form: .......................................................................................................................................................................

        Broj (JMBG ili matični broj) - Number (identification number / tax number): ..........................................................................................

        Zanimanje / djelatnost – Occupation: .....................................................................................................................................................

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

                Ulica i broj – Street and number: ....................................................................................................................................................

                Poštanski broj – Postal code: ...................................................Grad – City: ..................................................................................

                Država – State: ...............................................................................................................................................................................

 

 

II.     PODACI O PODNOSITELJU ZAHTJEVA - DavateljU licence – INFORMATION ON THE CLAIMANT – LICENSOR:

        Ime i prezime / naziv tvrtke – Full name / business name: ....................................................................................................................

        Pravni oblik - Legal form: .......................................................................................................................................................................

        Broj – Number: .......................................................................................................................................................................................

        Zanimanje / djelatnost – Occupation:

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

                Ulica i broj – Street and number: ....................................................................................................................................................

                Poštanski broj – Postal code: .............................................Grad – City: ................................................................................……

                Država – State: ...............................................................................................................................................................................

 

        Ime i prezime / naziv zastupnika (ako ga ima) – Name of the representative (if any): ..........................................................................

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

 

 

 

III.    Predmet ugovora o licenci – SUBJECT MATTER OF LICENCE:

 

3.1. Prava intelektualnog vlasništva – Intellectual property rights

3.1.1. Vrste prava intelektualnog vlasništva – Form of intellectual property right:

                ........................................................................................................................................................................................................

                ........................................................................................................................................................................................................

3.1.2. Registracija prava intelektualnog vlasništva – Registration of intellectual property right:

                Država registracije – Country of registration: .................................................................................................................................

                Broj registracije – Registration number: .........................................................................................................................................

Datum registracije – Date of registration: .......................................................................................................................................

        3.1.3. Nositelj prava intelektualnog vlasništva prema registru – Registered owner  of intellectual property right:

                Ime i prezime / naziv tvrtke – Full name / business name: ............................................................................................................

                Pravni oblik - Legal form: ...............................................................................................................................................................

                Zanimanje / djelatnost – Occupation: .............................................................................................................................................

                Prebivalište / sjedište – Address: ...................................................................................................................................................

                        Ulica i broj – Street and number: ...........................................................................................................................................

                        Poštanski broj – Postal code: ................................................Grad – City: ............................................................................

                        Država – State: .....................................................................................................................................................................

        3.2. Prava na korištenje pokretnina (između ostalog leasing-ugovori) – Right to use  movable property (under a leasing or an other agreement)

3.2.1. Vrste pokretnina – Type of movable property:.............................................................................................................................

                ........................................................................................................................................................................................................

3.3 Autorska prava (prava koja ne spadaju pod točku 3.1) – Copyrights (other than those under paragraph 3.1)

3.3.1. Vrste autorskog prava – Form of copyright: .................................................................................................................................

3.3.2. Naziv zaštićenog djela – Title of protected work: ........................................................................................................................

3.3.3. Autor - Author

        Ime – Name: ...................................................................................................................................................................................

Prezime – Surname: .......................................................................................................................................................................

                Prebivalište / sjedište – Address:

                        Ulica i broj – Street and number: ...........................................................................................................................................

                        Poštanski broj – Postal code: ...............................................Grad – City: ............................................................................

                        Država – State: .....................................................................................................................................................................

3.3.4. Davatelj licence ovlašten je za davanje licence na temelju – The licensor is authorized to grant licence by virtue of:

..............................................................................................................................................................................................................

 

 

IV.   PODACI O DOHOTKU – DESCRIPTION OF THE INCOME:

        Ukupan iznos dohotka– Total amount of income: ..................................................................................................................................

        Datum isplate – Date of payment: ..........................................................................................................................................................

        Ukupan iznos poreza – Total amount of tax:  ........................................................................................................................................

 

 

V.    PRILOŽENI DOKUMENTI (broj i naziv) – Documents attached (number and title):.................................................................….

        ...............................................................................................................................................................................................................

 

VI.   NAČIN POVRATA VIŠE PLAĆENOG POREZA – procedure of the refund:

        U Republici Hrvatskoj ili u – In the Republic of Croatia or in: .................................................................................................................

        Na broj računa – To the account number: ..........................................................................................................................…………….

        Kod (banka) – With the (Bank):................................................................................................................................................

        Otvorenog na ime – Opened in the name of: .........................................................................................................................................

 

VII.  IZJAVA PODNOSITELJA ZAHTJEVA – STATEMENT OF THE CLAIMANT:

        Potpisnik jamči da su gore navedeni podaci istiniti te da podnositelj zahtjeva, naveden pod točkom II., ispunjava slijedeće uvjete – The undersigned certifies that the beneficial owner  mentioned under II fulfills the following conditions:

        1.     Stvarni je korisnik gore navedenog dohotka – He is the beneficial owner of the mentioned income,

        2.     Dohodak u smislu navedenog Ugovora o izbjegavanju dvostrukog oporezivanja nije ostvaren kroz djelatnost registriranu u Republici Hrvatskoj – He did not derive income, as defined in the mentioned Agreement for the avoidance of  double taxation, through the activity registered in the Republic of Croatia,

        Poznato mi je da Porezna uprava Republike Hrvatske može poreznom tijelu u državi rezidentnosti podnositelja zahtjeva davati podatke o sadržaju ovog zahtjeva – I am aware of the fact that the Croatian Tax Administration can disclose the information given in this Application to the tax authorities in the country of residence of the claimant.

 

                ....................................................                                                                            ..........................................

                Mjesto i datum – Place and date                                                                                    Potpis - Signature

 

VIII. POTVRDA POREZNOG TIJELA DRŽAVE REZIDENTNOSTI PODNOSITELJA ZAHTJEVA – CERTIFICATE OF TAX AUTHORITY OF CLAIMANT´S COUNTRY OF RESIDENCE:

        Podnositelj zahtjeva je rezident .................................. prema članku ............... Ugovora o izbjegavanju dvostrukog oporezivanja između Republike Hrvatske i .................................... – The claimant is the resident of ................................... under Article .......... of the Agreement for the avoidance of double taxation between the Republic of Croatia and ....................................

       

 

 

        ....................................................                    .....................................................                           ....................................................

        Mjesto i datum  - Place and date                                     Pečat - Stamp                                                     Potpis - Signature

 

 

PRIMJERAK 3

- za Poreznu upravu Republike Hrvatske -

COPY 3

- for the Tax Administration of the Republic of Croatia -

R E P U B L I K A  H R V A T S K A

MINISTARSTVO FINANCIJA – POREZNA UPRAVA

THE REPUBLIC OF CROATIA

MINISTRY OF FINANCE – TAX ADMINISTRATION

 

 

 

ZAHTJEV ZA UMANJENJE POREZNE OBVEZE, IZUZIMANJE OD POREZA ILI POVRAT VIŠE PLAĆENOG POREZA

NA LICENCE I SLIČNA DAVANJA PREMA UGOVORU O IZBJEGAVANJU DVOSTRUKOG OPOREZIVANJA IZMEĐU

REPUBLIKE HRVATSKE I ………………………………

("Narodne novine – Međunarodni ugovori", broj: ..…)

APPLICATION FOR TAX RELIEF, TAX EXEMPTION OR TAX REFUND FOR ROYALTIES UNDER

THE AGREEMENT  FOR THE AVOIDANCE OF DOUBLE TAXATION BETWEEN

THE REPUBLIC OF CROATIA AND .........................................

("Official Gazette – International Agreements", number: ..…)

 

 

Podaci iz ovog Zahtjeva potrebni su zbog primjene članka 23. Zakona o porezu na dohodak ("Narodne novine", broj 127/00.) i članka 22. Zakona o porezu na dobit ("Narodne novine", broj 127/00.) – The data to be given in this application are requested under Article 23 of Income Tax Act ("Official Gazette", number 127/00) and Article 22 of Profit Tax Act ("Official Gazette", number 127/00)

 

 

 

I.              PODACI O StjecateljU licence – INFORMATION ON THE LICENSEE:

        Ime i prezime / naziv tvrtke – Full name / business name: ....................................................................................................................

        Pravni oblik - Legal form: .......................................................................................................................................................................

        Broj (JMBG ili matični broj) - Number (identification number / tax number): ..........................................................................................

        Zanimanje / djelatnost – Occupation: .....................................................................................................................................................

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

                Ulica i broj – Street and number: ....................................................................................................................................................

                Poštanski broj – Postal code: ..................................................Grad – City: ..................................................................................

                Država – State: ...............................................................................................................................................................................

 

 

II.     PODACI O PODNOSITELJU ZAHTJEVA - DavateljU licence – INFORMATION ON THE CLAIMANT – LICENSOR:

        Ime i prezime / naziv tvrtke – Full name / business name: ....................................................................................................................

        Pravni oblik - Legal form: .......................................................................................................................................................................

        Broj – Number: .......................................................................................................................................................................................

        Zanimanje / djelatnost – Occupation:

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

                Ulica i broj – Street and number: ....................................................................................................................................................

                Poštanski broj – Postal code: .................................................Grad – City: ..................................................................................

                Država – State: ...............................................................................................................................................................................

 

        Ime i prezime / naziv zastupnika (ako ga ima) – Name of the representative (if any): ..........................................................................

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

 

 

 

III.    Predmet ugovora o licenci – SUBJECT MATTER OF LICENCE:

 

3.1. Prava intelektualnog vlasništva – Intellectual property rights

3.1.1. Vrste prava intelektualnog vlasništva – Form of intellectual property right:

                ........................................................................................................................................................................................................

                ........................................................................................................................................................................................................

3.1.2. Registracija prava intelektualnog vlasništva – Registration of intellectual property right:

                Država registracije – Country of registration: .................................................................................................................................

                Broj registracije – Registration number: .........................................................................................................................................

Datum registracije – Date of registration: .......................................................................................................................................

        3.1.3. Nositelj prava intelektualnog vlasništva prema registru – Registered owner  of intellectual property right:

                Ime i prezime / naziv tvrtke – Full name / business name: ............................................................................................................

                Pravni oblik - Legal form: ...............................................................................................................................................................

                Zanimanje / djelatnost – Occupation: .............................................................................................................................................

                Prebivalište / sjedište – Address: ...................................................................................................................................................

                        Ulica i broj – Street and number: ...........................................................................................................................................

                        Poštanski broj – Postal code: ................................................Grad – City: ............................................................................

                        Država – State: .....................................................................................................................................................................

        3.2. Prava na korištenje pokretnina (između ostalog leasing-ugovori) – Right to use  movable property (under a leasing or an other agreement)

3.2.1. Vrste pokretnina – Type of movable property:.............................................................................................................................

                ........................................................................................................................................................................................................

3.3 Autorska prava (prava koja ne spadaju pod točku 3.1) – Copyrights (other than those under paragraph 3.1)

3.3.1. Vrste autorskog prava – Form of copyright: .................................................................................................................................

3.3.2. Naziv zaštićenog djela – Title of protected work: ........................................................................................................................

3.3.3. Autor - Author

        Ime – Name: ...................................................................................................................................................................................

Prezime – Surname: .......................................................................................................................................................................

                Prebivalište / sjedište – Address:

                        Ulica i broj – Street and number: ...........................................................................................................................................

                        Poštanski broj – Postal code: ...................................................Grad – City: ................................................................……..

                        Država – State: .....................................................................................................................................................................

3.3.4. Davatelj licence ovlašten je za davanje licence na temelju – The licensor is authorized to grant licence by virtue of:

..............................................................................................................................................................................................................

 

 

IV.   PODACI O DOHOTKU – DESCRIPTION OF THE INCOME:

        Ukupan iznos dohotka– Total amount of income: ..................................................................................................................................

        Datum isplate – Date of payment: ..........................................................................................................................................................

        Ukupan iznos poreza – Total amount of tax:  ........................................................................................................................................

 

 

V.    PRILOŽENI DOKUMENTI (broj i naziv) – Documents attached (number and title):......................................................................

        ...............................................................................................................................................................................................................

 

VI.   NAČIN POVRATA VIŠE PLAĆENOG POREZA – procedure of the refund:

        U Republici Hrvatskoj ili u – In the Republic of Croatia or in: .................................................................................................................

        Na broj računa – To the account number: ....................................................................................................................................…….

        Kod (banka) – With the (Bank): ...................................................……………………………………………………………………………..

        Otvorenog na ime – Opened in the name of: .........................................................................................................................................

 

VII.  IZJAVA PODNOSITELJA ZAHTJEVA – STATEMENT OF THE CLAIMANT:

        Potpisnik jamči da su gore navedeni podaci istiniti te da podnositelj zahtjeva, naveden pod točkom II., ispunjava slijedeće uvjete – The undersigned certifies that the beneficial owner  mentioned under II fulfills the following conditions:

        1.     Stvarni je korisnik gore navedenog dohotka – He is the beneficial owner of the mentioned income,

        2.     Dohodak u smislu navedenog Ugovora o izbjegavanju dvostrukog oporezivanja nije ostvaren kroz djelatnost registriranu u Republici Hrvatskoj – He did not derive income, as defined in the mentioned Agreement for the avoidance of  double taxation, through the activity registered in the Republic of Croatia,

        Poznato mi je da Porezna uprava Republike Hrvatske može poreznom tijelu u državi rezidentnosti podnositelja zahtjeva davati podatke o sadržaju ovog zahtjeva – I am aware of the fact that the Croatian Tax Administration can disclose the information given in this Application to the tax authorities in the country of residence of the claimant.

 

                ....................................................                                                                            ..........................................

                Mjesto i datum – Place and date                                                                                    Potpis - Signature

 

VIII. POTVRDA POREZNOG TIJELA DRŽAVE REZIDENTNOSTI PODNOSITELJA ZAHTJEVA – CERTIFICATE OF TAX AUTHORITY OF CLAIMANT´S COUNTRY OF RESIDENCE:

        Podnositelj zahtjeva je rezident .................................. prema članku ............... Ugovora o izbjegavanju dvostrukog oporezivanja između Republike Hrvatske i .................................... – The claimant is the resident of ................................... under Article .......... of the Agreement for the avoidance of double taxation between the Republic of Croatia and ....................................

       

 

 

        ....................................................                    .....................................................                           ....................................................

        Mjesto i datum  - Place and date                                     Pečat - Stamp                                                     Potpis - Signature

 

 

VIII. NAPOMENE POREZNE UPRAVE REPUBLIKE HRVATSKE (ako ih ima) – CROATIAN TAX AUTHORITIES REMARKS (if any)

 

 

 

 

PRIMJERAK 4

- za inozemno porezno tijelo -

COPY 4

- for the foreign tax authotity -

 

 

R E P U B L I K A  H R V A T S K A

MINISTARSTVO FINANCIJA – POREZNA UPRAVA

THE REPUBLIC OF CROATIA

MINISTRY OF FINANCE – TAX ADMINISTRATION

 

 

 

ZAHTJEV ZA UMANJENJE POREZNE OBVEZE, IZUZIMANJE OD POREZA ILI POVRAT VIŠE PLAĆENOG POREZA

NA LICENCE I SLIČNA DAVANJA PREMA UGOVORU O IZBJEGAVANJU DVOSTRUKOG OPOREZIVANJA IZMEĐU

REPUBLIKE HRVATSKE I ………………………………

("Narodne novine – Međunarodni ugovori", broj: ..…)

APPLICATION FOR TAX RELIEF, TAX EXEMPTION OR TAX REFUND FOR ROYALTIES UNDER

THE AGREEMENT  FOR THE AVOIDANCE OF DOUBLE TAXATION BETWEEN

THE REPUBLIC OF CROATIA AND .........................................

("Official Gazette – International Agreements", number: ..…)

 

 

Podaci iz ovog Zahtjeva potrebni su zbog primjene članka 23. Zakona o porezu na dohodak ("Narodne novine", broj 127/00.) i članka 22. Zakona o porezu na dobit ("Narodne novine", broj 127/00.) – The data to be given in this application are requested under Article 23 of Income Tax Act ("Official Gazette", number 127/00) and Article 22 of Profit Tax Act ("Official Gazette", number 127/00)

 

 

 

I.              PODACI O StjecateljU licence – INFORMATION ON THE LICENSEE:

        Ime i prezime / naziv tvrtke – Full name / business name: ....................................................................................................................

        Pravni oblik - Legal form: .......................................................................................................................................................................

        Broj (JMBG ili matični broj) - Number (identification number / tax number): ..........................................................................................

        Zanimanje / djelatnost – Occupation: .....................................................................................................................................................

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

                Ulica i broj – Street and number: ....................................................................................................................................................

                Poštanski broj – Postal code: .....................................................Grad – City: .......................................................................…….

                Država – State: ...............................................................................................................................................................................

 

 

II.     PODACI O PODNOSITELJU ZAHTJEVA - DavateljU licence – INFORMATION ON THE CLAIMANT – LICENSOR:

        Ime i prezime / naziv tvrtke – Full name / business name: ....................................................................................................................

        Pravni oblik - Legal form: .......................................................................................................................................................................

        Broj – Number: .......................................................................................................................................................................................

        Zanimanje / djelatnost – Occupation:

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

                Ulica i broj – Street and number: ....................................................................................................................................................

                Poštanski broj – Postal code: .....................................................Grad – City: ...........................................................................….

                Država – State: ...............................................................................................................................................................................

 

        Ime i prezime / naziv zastupnika (ako ga ima) – Name of the representative (if any): ..........................................................................

        Prebivalište / sjedište – Address: ...........................................................................................................................................................

 

 

 

III.    Predmet ugovora o licenci – SUBJECT MATTER OF LICENCE:

 

3.1. Prava intelektualnog vlasništva – Intellectual property rights

3.1.1. Vrste prava intelektualnog vlasništva – Form of intellectual property right:

                ........................................................................................................................................................................................................

                ........................................................................................................................................................................................................

3.1.2. Registracija prava intelektualnog vlasništva – Registration of intellectual property right:

                Država registracije – Country of registration: .................................................................................................................................

                Broj registracije – Registration number: .........................................................................................................................................

Datum registracije – Date of registration: .......................................................................................................................................

        3.1.3. Nositelj prava intelektualnog vlasništva prema registru – Registered owner  of intellectual property right:

                Ime i prezime / naziv tvrtke – Full name / business name: ............................................................................................................

                Pravni oblik - Legal form: ...............................................................................................................................................................

                Zanimanje / djelatnost – Occupation: .............................................................................................................................................

                Prebivalište / sjedište – Address: ...................................................................................................................................................

                        Ulica i broj – Street and number: ...........................................................................................................................................

                        Poštanski broj – Postal code: ...................................................Grad – City: ........................................................................

                        Država – State: .....................................................................................................................................................................

        3.2. Prava na korištenje pokretnina (između ostalog leasing-ugovori) – Right to use  movable property (under a leasing or another agreement)

3.2.1. Vrste pokretnina – Type of movable property:.............................................................................................................................

                ........................................................................................................................................................................................................

3.3 Autorska prava (prava koja ne spadaju pod točku 3.1) – Copyrights (other than those under paragraph 3.1)

3.3.1. Vrste autorskog prava – Form of copyright: .................................................................................................................................

3.3.2. Naziv zaštićenog djela – Title of protected work: ........................................................................................................................

3.3.3. Autor - Author

        Ime – Name: ...................................................................................................................................................................................

Prezime – Surname: .......................................................................................................................................................................

                Prebivalište / sjedište – Address:

                        Ulica i broj – Street and number: ...........................................................................................................................................

                        Poštanski broj – Postal code: ...................................................Grad – City: .........................................................................

                        Država – State: .....................................................................................................................................................................

3.3.4. Davatelj licence ovlašten je za davanje licence na temelju – The licensor is authorized to grant licence by virtue of:

..............................................................................................................................................................................................................

 

 

IV.   PODACI O DOHOTKU – DESCRIPTION OF THE INCOME:

        Ukupan iznos dohotka– Total amount of income: ..................................................................................................................................

        Datum isplate – Date of payment: ..........................................................................................................................................................

        Ukupan iznos poreza – Total amount of tax:  ........................................................................................................................................

 

 

V.    PRILOŽENI DOKUMENTI (broj i naziv) – Documents attached (number and title):......................................................................

        ...............................................................................................................................................................................................................

 

VI.   NAČIN POVRATA VIŠE PLAĆENOG POREZA – procedure of the refund:

        U Republici Hrvatskoj ili u – In the Republic of Croatia or in: .................................................................................................................

        Na broj računa – To the account number: .............................................................................................................................................

        Kod (banka) – With the(Bank): ....................................................…………………………………………………………………………….

        Otvorenog na ime – Opened in the name of: .........................................................................................................................................

 

VII.  IZJAVA PODNOSITELJA ZAHTJEVA – STATEMENT OF THE CLAIMANT:

        Potpisnik jamči da su gore navedeni podaci istiniti te da podnositelj zahtjeva, naveden pod točkom II., ispunjava slijedeće uvjete – The undersigned certifies that the beneficial owner  mentioned under II fulfills the following conditions:

        1.     Stvarni je korisnik gore navedenog dohotka – He is the beneficial owner of the mentioned income,

        2.     Dohodak u smislu navedenog Ugovora o izbjegavanju dvostrukog oporezivanja nije ostvaren kroz djelatnost registriranu u Republici Hrvatskoj – He did not derive income, as defined in the mentioned Agreement for the avoidance of  double taxation, through the activity registered in the Republic of Croatia,

        Poznato mi je da Porezna uprava Republike Hrvatske može poreznom tijelu u državi rezidentnosti podnositelja zahtjeva davati podatke o sadržaju ovog zahtjeva – I am aware of the fact that the Croatian Tax Administration can disclose the information given in this Application to the tax authorities in the country of residence of the claimant.

 

                ....................................................                                                                            ..........................................

                Mjesto i datum – Place and date                                                                                    Potpis - Signature

 

VIII. POTVRDA POREZNOG TIJELA DRŽAVE REZIDENTNOSTI PODNOSITELJA ZAHTJEVA – CERTIFICATE OF TAX AUTHORITY OF CLAIMANT´S COUNTRY OF RESIDENCE:

        Podnositelj zahtjeva je rezident .................................. prema članku ............... Ugovora o izbjegavanju dvostrukog oporezivanja između Republike Hrvatske i .................................... – The claimant is the resident of ................................... under Article .......... of the Agreement for the avoidance of double taxation between the Republic of Croatia and ....................................

       

 

 

        ....................................................                    .....................................................                           ....................................................

        Mjesto i datum  - Place and date                                     Pečat - Stamp                                                     Potpis - Signature

 

 

 

UPUTA ZA POPUNJAVANJE: LICENCE

 

 

5.      Ovaj obrazac podnosi se radi umanjenja porezne obveze, izuzimanja od poreza ili povrata više plaćenog poreza za licence i slična davanja osobi koja ima prebivalište, uobičajeno boravište ili sjedište (rezidentu) u državi s kojom je Republika Hrvatska sklopila Ugovor o izbjegavanju dvostrukog oporezivanja.

 

6.      Obrazac se sastoji od četiri primjerka. Prvi je primjerak za podnositelja zahtjeva, drugi za isplatitelja, treći za Poreznu upravu Ministarstva financija Republike Hrvatske, a četvrti za inozemno porezno tijelo. Točke II, IV, V i VI popunjava podnositelj zahtjeva, točke I i III popunjava isplatitelj, a točku VII popunjava inozemno porezno tijelo. Popunjeni i potpisani primjerci obrasca predaju se inozemnim poreznim tijelima zemlje koje je primatelj rezident. Inozemna porezna tijela će provesti potrebnu kontrolu, ovjeriti predočeni obrazac i zadržati svoj primjerak, a podnositelju zahtjeva vratiti preostala tri primjerka (za podnositelja zahtjeva, isplatitelja i Poreznu upravu Ministarstva financija Republike Hrvatske).

 

7.      Za svakog isplatitelja i za svaku isplatu podnosi se poseban zahtjev.

 

8.      Zahtjev za umanjenje porezne obveze, izuzimanje od poreza ili povrat više plaćenog poreza podnosi se Ministarstvu financija Republike Hrvatske, Poreznoj upravi, Područnom uredu Zagreb, Avenija Dubrovnik 32,  najkasnije u roku od tri godine od isteka kalendarske godine u kojoj je isplata izvršena.

 

 

 

INSTRUCTIONS FOR FILLING IN THE FORM: ROYALTIES

 

 

5.      This form is submitted for tax relief, tax exemption or tax refund for royalties to a resident of the country with which the Republic of Croatia entered into Agreement for the Avoidance of Double Taxation.

 

6.      The form consists of four copies. The first copy is for the claimant, the second for the payer of the income, the third copy for the Tax Administration of the Republic of Croatia, and the forth copy for the foreign tax authority. Items II, IV, V  and VI are to be filled in by the claimant, items I and III  by the payer of the income, and the item VII by the foreign tax authority. The filled in and signed copies of the form are submitted to the tax authorities of the country in which the recipient is resident. Foreign tax authorities shall carry out the required control, certify a submitted form, and retain their own copy, and return the three remaining copies to the claimant (for the claimant, payer of the income, and the Tax Administration of the Republic of Croatia).

 

7.      For each payer and for each payment a separate claim is made.

 

8.      Application for tax relief, tax exemption or tax refund is submitted to the Ministry of Finance of the Republic of Croatia, Tax Administration, Zagreb office, Avenija Dubrovnik 32, at latest within 3 years as of expiry of the calendar year in which the payment is effected.

 

 

 

 

 

Ostalo, NN 1/2001-31
Više
Dio NN: Službeni
Vrsta dokumenta: Ostalo
Izdanje: NN 1/2001   
Broj dokumenta u izdanju: 31
Donositelj:Glavna urednica
Datum tiskanog izdanja: 5.1.2001.
ELI: /eli/sluzbeni/2001/1/31