Bijlage 1 Verrekening van buitenlandse bronbelasting voor Nederlandse vaste inrichtingen: model vaste inrichting-verklaring

Dear sir, The reason for this declaration is that <name enterprise> has declared: Given the above-mentioned I declare:

– that <name enterprise>, that carries on its business in the Netherlands through a permanent establishment, will receive a/an dividend/interest/royalty to the amount of <amount>,
– that this dividend/interest/royalty will be payable on <date> by <name + adress>;
– that this dividend/interest/royalty can be attributed to the permanent establishment situated in the Netherlands;
– that this dividend/interest/royalty is subject to a <...> percent witholding tax in <source state>, this to the amount of <amount of withholding tax>.
– that the enterprise of <name enterprise> carries on its business in the Netherlands through a permanent establishment within the meaning of the Convention for the avoidance of double taxation between the Netherlands and <name country where the head office of the enterprise is situated>;
– that the profits of the <name enterprise> enterprise for as far as they are attributed to the permanent establishment, are subject to Dutch corporation tax.