France: 2023 version of Forms 5000 and 5001


Clearstream Banking1informs clients that the French Tax Authorities (FTA) have published new versions of Form 5000 (Affidavit of residence) and Form 5001 (Calculation of withholding tax on dividends), as well as the related explanatory notices; and that effective


clients must provide the latest 2023 versions of Form 5000 when claiming the benefit under the double taxation treaty through the simplified procedure, and of Form 5001 for relief at source under the parent-subsidiary regime or for the normal procedure (standard refund).


The Forms 5000 and 5001 (the "forms"), as well as the explanatory notices,  have been published on FTA’s website under “Millésime 2023”. 

Form 5000 – Affidavit of residence (CERFA 12816*04)

The following changes were brought into this new version:

  • The English version of box III Beneficiary’s declaration has been amended to be fully aligned with the French version. It now reflects the “subject-to-tax” requirement. In particular, the wording of the third indent of Box III has been amended as follows: “Due to my legal form or business activity, I am subject to the tax under the laws of ................. (name of country of residence), including with respect to French-source dividends ….”
  • Box VI Declaration of US financial institution: both a signature and a seal are required while previous version only required a seal.
  • In the Portuguese version of Form 5000, the copy in French language is no longer missing.

Notice 5000 – Affidavit of residence (CERFA 51147#05)

The notice was only slightly updated to include the acceptance of a separate certificate of residence (COR) in paper form in replacement of certification by the foreign tax authorities in box IV of Form 5000. The version modified in 2022 was only referring to electronic CORs.

Form 5001 – Calculation of withholding tax on dividends (CERFA 12816*05)

On page 1 (front page)

  • The box "Recipient's name" (top left) has been reinstated;

On page 2 (back page)

  • A reference to the domestic law has been included in the title of column 9 as follows: “Withholding tax due under the applicable tax treaty or domestic law”.

In the Portuguese version of Form 5001, the copy in French language is no longer missing.

The 2022 versions of Forms 5000 and 5001, as well as the explanatory notices, are available in French, English, Spanish, German, Italian, Dutch and Portuguese. The Chinese versions are still being finalised and are not yet available on the FTA’s website. .

Impact on clients

When applying for tax treaty benefits on French-sourced dividends through the simplified procedure, quick refund or standard refund, beneficiaries must always use the most recent version of the Forms as published by the FTA. 

Beneficial owners completing forms 5000 and 5001 from now on must use the most recent versions. 

If clients have collected old versions (5000-CERFA 12816*03 or 5001-CERFA 12816*04) from the beneficial owners, those can still be accepted on condition that the forms have been completed correctly and have been signed by the beneficial owners prior to 30 June 2023. Past this date, only the new versions will be accepted. 

If a request for simplified procedure or standard refund is rejected because the forms have been completed incorrectly or are incomplete, the new versions of the forms will be required.

If a request for simplified procedure or standard refund is rejected because other supporting documentation is incorrect or missing while the forms are correctly completed, the new versions of the forms will not be required.

Further information

For further information, please refer to the Market Taxation Guide – France (securities held in CBF).
1. Clearstream Banking refers collectively to Clearstream Banking AG, registered office at 61, Mergenthalerallee, 65760 Eschborn, Germany and registered in Register B of the Amtsgericht Frankfurt am Main, Germany under number HRB 7500, and Clearstream Banking S.A., registered office at 42, avenue John F. Kennedy, L-1855 Luxembourg, and registered with the Luxembourg Trade and Companies Register under number B-9248.