CERTIFICADO DE RESIDENCIA FISCAL
Las autoridades Fiscales de___________________________________________	(1) certifican que:
L'Administration Fiscale de___________________________________________	(1) certific que:
The Tax Authorities of_______________________________________________	(1) certify that:
Le Autorità Tributarie________________________________________________	(1) certificano one:
Die Finanzbehörden von_____________________________________________ (1) bescheinigen, daß:
As autoridades Fiscais de_____________________________________________ (1) certificam, que:
__________________________________________________________________  (1) ______________:

En cuanto le es posible conocer__________________________________________________________ (2)
À leur connaissance___________________________________________________________________  (2)
To the best of their knowledge___________________________________________________________ (2)
Per quanto a loro conoscenza____________________________________________________________ (2)
Nach unseren Kenntnissen,______________________________________________________________ (2)
Tanto quanto é do seu conhecimento______________________________________________________ (2)
___________________________    ___________________________________________________ (2)

Es residente en_____________________________________________________________________ (1)
Est resident en_____________________________________________________________________ (1)
Is a resident of____________________________________________________________________ (1)
E’ residente in____________________________________________________________________ (1)
In (Anschrift)_________________________________________________________________________ (1)
Éresidence em_________________________________________________________________________ (1)
____________    ____________________________________________________________________(1)

En el sentido del Convenio entre España y_________________________________________________ (1)
Au sens de la Convention entre L'Espagne et______________________________________________ (1)
Within the meaning of the Spain____________________________________________(1) tax Convention
Ai sensi della Convenzione Spagna_______________________________________________________ (1)
Im Sinne des Spanischen_____________________________________(1) Doppelbesteuerungsabkommen
Nos termos da Convençao entre Espanha e________________________________________________(1) ____________    ____________________________________________________________________(1)

En	     Fecha	
A	      Date	
Done at	    The	
Luogo	       Data	
In	       Datum	
Em	       Data	
_____________________________________       ____________________________________________
Sello	Firma
Cachet	Signature
Stamp	Sinature
Timbre	Firma
Stempel mit Anschrift	Unterschrift
Solo	Assinatura
(1) Pais de residencia del Perceptor de Rentas. Pays de residence de beneficiaire des revenues. Country of residence of beneficiary.
(2) Nombre y apellidos o raz6n social del perceptor de las rentas. Prenom, nom or raison sociale du beneficiaire. Full name or company name of beneficiary.