Royalty Payment Withholding Tax Certificate
Certificate No.:
Date of Issue:
Payer Details
Name:
Address:
Tax ID:
Payee Details
Name:
Address:
Tax ID / Registration No.:
Country of Residence:
Royalty Payment Details
Description of Royalty
Gross Payment Amount
Withholding Tax Rate (%)
Withholding Tax Amount
Net Payment Amount
Date of Payment
Remarks / Reference (if any):
Authorized Signature (Payer)
Company Stamp / Seal