Individual Tax Residency Self-Certification Form CRS-I
Please read these instructions before completing the form
Regulations based on the OECD Common Reporting Standard (“CRS”) require FidBank UK Limited to collect and report certain information about an account holder’s tax residence. Each jurisdiction has its own rules for defining tax residence, and jurisdictions have provided information on how to determine if you are resident in the jurisdiction on the following website: http://www.oecd.org/tax/automatic-exchange/about-automatic-exchange/. In general, you will find that tax residence is the country/jurisdiction in which you live. Special circumstances may cause you to be resident elsewhere or resident in more than one country/jurisdiction at the same time (dual residency).
If you are a U.S. citizen or tax resident under U.S. law, you should indicate that you are a U.S. tax resident on this form and you may also need to fill in an IRS W-9 form. For more information on tax residence, please consult your tax adviser or the information at the http://www.oecd.org/tax/automatic-exchange/about-automatic-exchange/If your tax residence (or the account holder, if you are completing the form on their behalf) is located outside the United Kingdom, we may be legally obliged to pass on the information in this form and other financial information with respect to your financial accounts to the UK tax authorities i.e. HMRC and they may exchange this information with tax authorities of another jurisdiction or jurisdictions pursuant to intergovernmental agreements to exchange financial account information.You can find summaries of defined terms such as an account holder, and other terms, in the Appendix.This form will remain valid unless there is a change in circumstances relating to information, such as the account holder’s tax status or other mandatory field information, that makes this form incorrect or incomplete. In that case you must notify us and provide an updated self-certification.This form is intended to request information consistent with local law requirements.Please fill in this form if you are an individual account holder, sole trader or sole proprietor.For joint or multiple account holders, use a separate form for each individual person.Where you need to self-certify on behalf of an entity account holder, do not use this form. Instead, you will need an “Entity tax residency self-certification.” Similarly, if you are a controlling person of an entity, please fill in a “Controlling person tax residency self-certification form” instead of this form.If you are filling in this form on behalf of someone else.Please tell us in what capacity you are signing in Part 3.For example, you may be the custodian or nominee of an account on behalf of the account holder, or you may be completing the form under a power of attorney.A legal guardian should complete the form on behalf of an account holder who is a minor.As a financial institution, we are not allowed to give tax advice.Your tax adviser may be able to assist you in answering specific questions on this form. Your domestic tax authority can provide guidance regarding how to determine your tax status.You can also find out more, including a list of jurisdictions that have signed agreements to automatically exchangeinformation, along with details about the information being requested, on the http://www.oecd.org/tax/automatic-exchange/about-automatic-exchange/
Individual Tax Residency Self-Certification Form CRS - I(please complete parts 1-3 in BLOCK CAPITALS)Part - 1 Identification of Individual Account Holder
B. Current Residence Address:
C. Mailing Address: (please only complete if different to the address shown in Section B)
E. Place of Birth
Part 2 – Country/Jurisdiction of Residence for Tax Purposes and related Taxpayer IdentificationNumber or equivalent number* (“TIN”) (See Appendix)Please complete the following table indicating (i) where the Account Holder is tax resident and (ii) the Account Holder’sTIN for each country/jurisdiction indicated. Countries/Jurisdictions adopting the wider approach may require that the self-certification include a tax identifying number for each country/jurisdiction of residence (rather than for each ReportableJurisdiction).If the Account Holder is tax resident in more than three countries/jurisdictions, please use a separate sheetIf a TIN is unavailable please provide the appropriate reason A, B or C where indicated below:Reason A - The country/jurisdiction where the Account Holder is resident does not issue TINs to its residents.
Reason B - The Account Holder is otherwise unable to obtain a TIN or equivalent number(Please explain why you are unable to obtain a TIN in the below table if you have selected this reason).
Reason C - No TIN is required. (Note. Only select this reason if the domestic law of the relevant jurisdiction does not require the collection of the TIN issued by such jurisdiction)
Please explain in the following boxes why you are unable to obtain a TIN if you selected Reason B above.
Part 3 – Declarations and Signature*
I understand that the information supplied by me is covered by the full provisions of the terms and conditions governing the Account Holder’s relationship with FidBank UK Limited setting out how FidBank UK Limited may use and share the information supplied by me.I acknowledge that the information contained in this form and information regarding the Account Holder and any Reportable Account(s) may be provided to the tax authorities of the country/jurisdiction in which this account(s) is/are maintained and exchanged with tax authorities of another country/jurisdiction or countries/jurisdictions in which the Account Holder may be tax resident pursuant to intergovernmental agreements to exchange financial accountinformation.I certify that I am the Account Holder (or am authorised to sign for the Account Holder) of all the account(s) to which this form relates.I declare that all statements made in this declaration are, to the best of my knowledge and belief, correct and complete. I undertake to advise FidBank UK Limited within 30 days of any change in circumstances which affects the tax residency status of the individual identified in Part 1 of this form or causes the information contained herein to become incorrect or incomplete, and to provide FidBank UK Limited with a suitably updated self-certification and Declaration within 30 days of such change in circumstances.
Note: If you are not the Account Holder please indicate the capacity in which you are signing the form. If signing under a power of attorney please also attach a certified copy of the power of attorney.
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