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ARTICLE 4 OF THE CONVENTION FOR THE AVOIDANCE OF DOUBLE TAXATION, IN , IN THE YEAR(S) ______ TO ______ AND IS /WAS SUBJECT TO INCOME TAX. LOCAL CITY DATA (AAAA/MM/DD DATE (YYYY/MM/DD) ASSINATURA E SELO OFICIAL SIGNATURE AND OFFICIAL STAMP _____________/________/________ ENTIDADE ENTITY EXEMPLAR DESTINADO À ENTIDADE OBRIGADA A EFECTUAR A RETENÇÃO NA FONTE COPY FOR THE ENTITY OBLIGED TO WITHHOLD TAX 1 DIRECÇÃO-GERAL REPÚBLICA PORTUGUESA MINISTÉRIO DAS FINANÇAS DSRI - Direcção .

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