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Fatca Form

The document outlines the FATCA/CRS Self Certification process for individual account holders and entities, detailing the required information for tax residency declaration and account treatment. It includes sections for personal identification, tax identification numbers, and compliance with tax regulations, emphasizing the importance of providing accurate and complete information. Additionally, it specifies the documentation needed for various scenarios and the obligations of account holders to report changes in their information promptly.

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jietfaisal
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© © All Rights Reserved
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0% found this document useful (0 votes)
54 views18 pages

Fatca Form

The document outlines the FATCA/CRS Self Certification process for individual account holders and entities, detailing the required information for tax residency declaration and account treatment. It includes sections for personal identification, tax identification numbers, and compliance with tax regulations, emphasizing the importance of providing accurate and complete information. Additionally, it specifies the documentation needed for various scenarios and the obligations of account holders to report changes in their information promptly.

Uploaded by

jietfaisal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 18

Annexure-I

(FATCA / CRS Self Certification / Annexure – Individual (incl. Sole


Proprietor)
(With reference to FORM NO. 61B of CBDT)

PART B: REPORT DETAILS


B. INDIVIDUAL DETAILS (To be provided for individual account holder )
Name
Account Number
(To be filled by Branch)
Customer ID(To be filled by Branch)
Tax residence declaration – tick any
one, as applicable to you: I am a tax resident of India and not resident of any other country
Or

I am a tax resident of the country/ies mentioned in the table below.

Country # Tax Identification Type


%
Identification (TIN or Other ,
Number% please specify)

Note: If the customer declares that he is Tax


Resident of other than India, the following details
must be obtained.

Name:
Signature:

Date: __/ ___/ ____ Place: _________

B.1 ACCOUNT DETAILS


B.1.1 Account Treatment
- N - New Account
- P – Preexsiting account
B.1.2 Documentation Status
- D – Documented(If KYC
&Tax documents obtained)
- U- Undocumented (When
KYC &Tax documents could
not obtained)

Father’s Name
Spouse’s Name
Gender
PAN
Aadhaar Number
Identification Type
Identification Number
Occupation Type
 S- Service
 B-Business
 O-Others
 X- Not Categorized
Occupation
Birth Date
Nationality
Country of Residence as per tax laws
Place of Birth
Country of Birth
Tax Identification Number (TIN)
allotted by tax resident country
TIN Issuing Country

Address Type
- Residential Or Business
- Residential
- Business
– Registered Office
– Unspecified
B.4.21 City / Town
B.4.22 Postal Code
B.4.23 State Code Insert 2 character
code
B.4.24 Country Code Insert 2
character code
B.4.25 Mobile/Telephone Number
B.4.26 Other Contact Number
#
To also include USA, where the individual is a citizen/ green card holder of USA
% $
In case Tax Identification Number is not available, kindly provide functional equivalent

Certification

I/We have understood the information requirements of this Form (read along with the FATCA/CRS
Instructions) and hereby confirm that the information provided by me/us on this Form is true, correct, and
complete. I/We also confirm that I/We have read and understood the FATCA CRS Terms and conditions
below and hereby accept the same.

Name:
Signature:

Date: __/ ___/ ____ Place: _________________________

2
FATCA-CRS Terms and Conditions

The Central Board of Direct Taxes has notified Rules 114F to 114H, as part of the Income-tax Rules, 1962, which
Rules require Indian financial institutions such as the Bank to seek additional personal, tax and beneficial owner
information and certain certifications and documentation from all our account holders. In relevant cases,
information will have to be reported to tax authorities/ appointed agencies. Towards compliance, we may also be
required to provide information to any institutions such as withholding agents for the purpose of ensuring
appropriate withholding from the account or any proceeds in relation thereto.

Should there be any change in any information provided by you, please ensure you advise us promptly, i.e.,
within 30 days.

Please note that you may receive more than one request for information if you have multiple relationships with ABC
or its group entities. Therefore, it is important that you respond to our request, even if you believe you have already
supplied any previously requested information.

FATCA-CRS Instructions

If you have any questions about your tax residency, please contact your tax advisor. If you are a US citizen or
resident or greencard holder, please include United States in the foreign country information field along with
your US Tax Identification Number.
$
It is mandatory to supply a TIN or functional equivalent if the country in which you are tax resident issues such
identifiers. If no TIN is yet available or has not yet been issued, please provide an explanation and attach this to the
form.
In case customer has the following Indicia pertaining to a foreign country and yet declares self to be non-tax
resident in the respective country, customer to provide relevant Curing Documents as mentioned below:

FATCA/ CRS Indicia observed Documentation required for Cure of FATCA/ CRS indicia
(ticked)
1. Self-certification that the account holder is neither a citizen of United States of
U.S. place of birth
America nor a resident for tax purposes;
2. Non-US passport or any non-US government issued document evidencing
nationality or citizenship (refer list below);AND
3. Any one of the following documents:
a. Certified Copy of “Certificate of Loss of Nationality or
b. Reasonable explanation of why the customer does not have such a certificate
despite renouncing US citizenship; or Reason the customer did not obtain U.S.
citizenship at birth
1. Self-certification that the account holder is neither a citizen of United States of
Residence/mailing address in a
America nor a tax resident of any country other than India; and
country other than India
2. Documentary evidence (refer list below)
If no Indian telephone number is provided
Telephone number in a country other
1. Self-certification that the account holder is neither a citizen of United States of
than India
America nor a tax resident of any country other than India; and
2. Documentary evidence (refer list below)

If Indian telephone number is provided along with a foreign country telephone


number
1. Self-certification that the account holder is neither a citizen of United States of
America nor a tax resident for tax purposes of any country other than India; OR
2. Documentary evidence (refer list below)
1. Self-certification that the account holder is neither a citizen of United States of
Standing instructions to transfer
America nor a tax resident of any country other than India; and
funds to an account maintained in a
2. Documentary evidence (refer list below)
country other than India (other than
depository accounts)

List of acceptable documentary evidence needed to establish the residence(s) for tax purposes:
1. Certificate of residence issued by an authorized government body*
2. Valid identification issued by an authorized government body* (e.g. Passport, National Identity card, etc.)
* Government or agency thereof or a municipality of the country or territory in which the payee claims to be a
resident.
FATCA CRS Self Declaration for Entities ANNEXURE II

Details of ultimate beneficial owner including additional FATCA & CRS information (please include other references for completeness sake)

1. Name of the entity: ____________


2. Customer ID: ____________
3. Address of tax residence(including city, state, country and pin code) _________
4. Address Type: ______________ (Business or Registered office)
5. Country of incorporation: ________
6. City of incorporation: __________
7. Entity Constitution Type: ________________
(A - Partnership Firm, B – HUF, C - Private Limited Company, D- Public Limited Company, E- Society, F- AOP/BOI, G – Trust, H – Liquidator, I– Limited
Liability Partnership, J- Artificial Juridical Person, Z – Others specify _________)
8. Date of Incorporation: ____________ (in DD/MM/YYYY format)(Mandatory if valid PAN is not reported)
9. PAN________
10. Identification type and Identification Number (if TIN or US GIIN not provided): Company Identification Number___________________, Global Entity
Identification Number______________, Other(please specify & provide)____________________
11. Issuing country for identification number provided in 10. Above ___________________

Please tick the applicable tax resident declaration:(Any one)

Entity is a tax resident of India and not resident of any other countryOR

Entity is a tax resident of the country/ies mentioned in the table below

Please indicate all the country/ies in which the entity is a resident for tax purposes and the associated Tax ID Number below:

Country Tax Identification Number% Identification Type (TIN or Other%, please specify)

1
FATCA CRS Self Declaration for Entities ANNEXURE II
%
In case Tax Identification Number is not available, kindly provide functional equivalent1

In case the Entity’s Country of Incorporation/Tax residence is U.S. but Entity is not a Specified U.S. Person, mention Entity’s exemption code2 here:
______________

FATCA & CRS declaration (Please consult your professional tax advisor for further guidance on FATCA& CRS classification)

Part A(to be filled by Financial Institutions or Direct Reporting NFEs)

1 We are a GIIN:______ GIIN not available (please tick as applicable):


Financial institution3or
Direct reporting NFE4 Note: If you do not have a GIIN but you are sponsored by Following options available only for Financial
(please tick as appropriate) another entity, please provide your sponsor’s GIIN above Institutions:
and indicate your sponsor’s name below:
Applied for
Name of sponsoring entity: ________________________
Not required to apply for (Please specify sub-
category5 _______)
Please provide with Form W8-BEN-E, duly filled in

Not obtained – Non-participating FI

1
It is mandatory to supply a TIN or functional equivalent if the country in which you are tax resident issues such identifiers. If no TIN is yet available or has not yet been issued, please
provide an explanation and attach this to the form.
2
Refer 3(viii) of Part D
3
Refer1 of Part D
4
Refer 3(vii) of Part D
5
Refer 1A. of Part D

2
FATCA CRS Self Declaration for Entities ANNEXURE II

Part B(please fillany one as appropriate; to be filled by NFEs other than Direct Reporting NFEs)
1 Is the Entity a publicly traded company6 (that is, a company whose Yes
shares are regularly traded on an established securities market)
(If yes, please specify any one stock exchange upon which the stock is regularly
traded)

Name of the stock exchange _______________


2 Is the Entity a related entity of a publicly traded company7 - a Yes
company whose shares are regularly traded on anestablished
securities market Name of the listed company, the stock of which is regularly traded
______________________
(If yes, please specify any one stock exchange upon which the stock is regularly
traded)

Name of the stock exchange ______________________


Nature of relation:
Subsidiary of the listed company
Controlled by a listed company

3 Is the Entity an active NFE8 Yes


Nature of business _____________________________

Please specify the sub-category of Active NFE:____


(Mention code – refer 2c of Part D)

4 Is the Entity a passiveNFE9 Yes

Nature of business _____________________________

6
Refer 2a of Part D
7
Refer 2b of Part D

8
Refer 2c of Part D
9
Refer 3(ii) of Part D

3
FATCA CRS Self Declaration for Entities ANNEXURE II

Part C (to be filled only by Passive NFEs)


10
Please list below the details of each controlling person(s) , confirming ALL countries of tax residency/ permanent residency/ citizenship and ALL Tax Identification
Numbers for EACH controlling persons (Please attach additional sheets if necessary):
Controlling Controlling Controlling Controlling Controlling Controlling
Person 1 Person 2 Person 3 Person 4 Person 5 Person 6
Name
Country of tax residency*

Address (include City State, Country &


Pin code)

Telephone/mobile number with ISD code

Tax identification number (or functional


equivalent) for each country identified in
relation to each person%

Identification Type (TIN or Other, please


specify)

Controlling person type code11

Additional details to be filled below ONLY by controlling persons having tax residency/permanent residency/citizenship in any
country other than India including green card holders:
Controlling Controlling Controlling Controlling Controlling Controlling
Person 1 Person 2 Person 3 Person 4 Person 5 Person 6
Customer ID (if allotted)

Gender
(Male, Female, Other)

10
Refer 3 (iv) of Part D
11
Refer 3(iv) (A) of Part D

4
FATCA CRS Self Declaration for Entities ANNEXURE II

City of Birth

Country of birth

Occupation Type (Service, Business,


Others)
Nationality
Father’s Name (if PAN not available)
Birth Date
PAN
Address type for address mentioned above
(Residence or business, Residential,
Business, Registered office)
Identification Type (Documents submitted
as proof of identity of the individual)@
Identification Number (Mandatory if PAN
or Aadhaar number is not reported)
Spouse’s name (optional)
Aadhaar Number (optional)

*To include US, where controlling person is a US citizen or green card holder
%
In case Tax Identification Number is not available, kindly provide functional equivalent1
@
Permissible values are:
 Passport
 Election ID card
 PAN Card
 ID Card
 Driving License
 UIDAI Letter
 NREGA Job card
 Others

5
FATCA CRS Self Declaration for Entities ANNEXURE II

FATCA CRS Terms and Conditions

The Central Board of Direct Taxes has notified Rules 114F to 114H, as part of the Income-tax Rules, 1962, which Rules require Indian financial institutions such as the
Bank to seek additional personal, tax and beneficial owner information and certain certifications and documentation from all our account holders. In relevant cases,
information will have to be reported to tax authorities/ appointed agencies. Towards compliance, we may also be required to provide information to any institutions such
as withholding agents for the purpose of ensuring appropriate withholding from the account or any proceeds in relation thereto.

Should there be any change in any information provided by you, please ensure you advise us promptly, i.e., within 30 days.

Please note that you may receive more than one request for information if you have multiple relationships with ABC or its group entities. Therefore, it is important that
you respond to our request, even if you believe you have already supplied any previously requested information.

If you have any questions about your tax residency, please contact your tax advisor. If you are a US citizen or resident or greencard holder, please include United
States in the foreign country information field along with your US Tax Identification Number.

Certification

I have understood the information requirements of this Form (read along with the FATCA/CRS Instructions) and hereby confirm that the information
provided by me on this Form is true, correct, and complete. I also confirm that I have read and understood the FATCA CRS Terms and Conditions and
hereby accept the same.

Name: ______________

Designation: __________

Signature:

Date: __/ ___/ ____ Place: _________________________

6
FATCA CRS Self Declaration for Entities ANNEXURE II

7
FATCA CRS Self Declaration for Entities ANNEXURE II
Part D: FATCA-CRS Instructions & Definitions

1. Financial Institution (FI)- The term FI means any financial institution that is a Depository Institution, Custodial Institution, Investment Entity or Specified
Insurance company, as defined.
(i) Depository institution: is an entity that accepts deposits in the ordinary course of banking or similar business.

(ii) Custodial institutionisan entity that holds as a substantial portion of its business, holds financial assets for the account of others and where it’sincome
attributale to holding financial assets and related financial services equals or exceeds 20 percent of the entity's gross income during the shorter of-

a) The three financial years preceding the year in which determination is made; or
b) The period during which the entity has been in existence,whichever is less.

(iii) Investment entityis any entity:


a) That primarily conducts a business or operates for or on behalf of a customer for any of the following activities or operations for or on behalf of a customer
(i) Trading in money market instruments (cheques, bills, certificates of deposit, derivatives, etc.); foreign exchange; exchange, interest rate and index
instrumens; transferable securities; or commodity futures trading; or
(ii) Individual and collective portfolio management;or
(iii) Investing, administering or managing funds,money or financial asset or money on behalf of other persons;
or

b) The gross income of which is primarily attributable to investing, reinvesting, or trading in financial assets, if the entity is managed by another entity that is a
depository institution, a custodial institution, a specified insurance company, or an investment entity described above.

An entity is treated as primarily conducting as a business one or more of the 3 activities described above, or an entity’s gross income is primarily attributable to
investing, reinvesting, or trading in financial assets of the entity’s gross income attributable to the relevant activities equals or exceeds 50 percent of the entity’s
gross income during the shorter of:
(i) the three-year period ending on 31 March of the year preceding the year in which the determination is made; or
(ii) the period during which the entity has been in existence.

The term “Investment Entity” does not include an entity that is an active non-financial entity as per codes 03, 04, 05 and 06 - refer point 2c. )

(iv) Specified Insurance Company: Entity that is an insurance company (or the holding company of an insurance company) that issues, or is obligated to make
payments with respect to, a Cash Value Insurance Contract or an Annuity Contract.

1A FIs not required to apply for GIIN:

8
FATCA CRS Self Declaration for Entities ANNEXURE II

Code Sub-category
01 Governmental Entity, International Organization or Central Bank
02 Treaty Qualified Retirement Fund; a Broad Participation Retirement Fund; a Narrow Participation Retirement Fund; or a
Pension Fund of a Governmental Entity, International Organization or Central Bank
03 Non-public fund of the armed forces, an employees’ state insurance fund, a gratuity fund or a provident fund
04 Entity is an Indian FI solely because it is an investment entity
05 Qualified credit card issuer
06 Investment Advisors, Investment Managers& Executing Brokers
07 Exempt collective investment vehicle
08 Trustee of an Indian Trust
09 FI with a local client base
10 Non-registering local banks
11 FFI with only Low-Value Accounts
12 Sponsored investment entity and controlled foreign corporation
13 Sponsored, Closely Held Investment Vehicle
14 Owner Documented FFI(if you select this category, please provideOwner Reporting Statement or an Auditor’s Letter with
required details as mentioned in Form W8 BEN E)

2. Non-financial entity (NFE) –Any entity that is not a financial institution


Types of NFEs that are regarded as excluded NFE are:

a.. Publicly traded company (listed company)


A company is publicly traded if its stock are regularly traded on one or more established securities markets
(Established securities market means an exchange that is officially recognized and supervised by a governmental authority in which the securities market is
located and that has a meaningful annual value of shares traded on the exchange)

b. Related entity of a publicly traded company


The NFE is a related entityof an entity of which is regularly traded on an established securities market;

c. Active NFE : (is any one of the following):


Code Sub-category
01 Less than 50 percent of the NFE’s gross income for the preceding financial yearis passive income and less than 50 percent of the assets held by
theNFE during the preceding financial year are assets that produce or are held for the production of passive income;
02 The NFE is a Governmental Entity, an International Organization, a Central Bank , or an entity wholly owned by one or more of the foregoing;

03 Substantially all of the activities of the NFEconsist of holding (in whole or in part) the outstanding stock of, or providing financing and services
to, one or more subsidiaries that engage in trades or businesses other than the business of a Financial Institution, except that an entity shall not

9
FATCA CRS Self Declaration for Entities ANNEXURE II

qualify for this status if the entity functions as an investment fund, such as a private equity fund, venture capital fund, leveraged buyout fund, or
any investment vehicle whose purpose is to acquire or fund companies and then hold interests in those companies as capital assets for investment
purposes;
04 The NFE is not yet operating a business and has no prior operating history, but is investing capital into assets with the intent to operate a business
other than that of a Financial Institution, provided that the NFE shall not qualify for this exception after the date that is 24 months after the date of
the initial organization of the NFE;
05 The NFE was not a Financial Institution in the past five years, and is in the process of liquidating its assets or is reorganizing with the intent to
continue or recommence operations in a business other than that of a Financial Institution;
06 The NFE primarily engages in financing and hedging transactions with, or for, Related Entities that are not Financial Institutions, and does not
provide financing or hedging services to any Entity that is not a Related Entity, provided that the group of any such Related Entities is primarily
engaged in a business other than that of a Financial Institution;
07 Any NFE that fulfills all of the following requirements:
 It is established and operated in India exclusively for religious, charitable, scientific, artistic, cultural, athletic, or educational purposes; or it is
established and operated in India and it is a professional organization, business league, chamber of commerce, labor organization, agricultural
or horticultural organization, civic league or an organization operated exclusively for the promotion of social welfare;
 It is exempt from income tax in India;
 It has no shareholders or members who have a proprietary or beneficial interest in its income or assets;
 The applicable laws of the NFE’s country or territory of residence or the NFE’s formation documents do not permit any income or assets of
the NFE to be distributed to, or applied for the benefit of, a private person or non-charitable Entity other than pursuant to the conduct of the
NFE’s charitable activities, or as payment of reasonable compensation for services rendered, or as payment representing the fair market value
of property which the NFE has purchased; and

The applicable laws of the NFE’s country or territory of residence or the NFE’s formation documents require that, upon the NFE’s liquidation or
dissolution, all of its assets be distributed to a governmental entity or other non-profit organization, or escheat to the government of the NFE’s
country or territory of residence or any political subdivision thereof.

Explanation.- For the purpose of this sub-clause, the following shall be treated as fulfilling the criteria provided in the said sub-clause, namely:-
(I) an Investor Protection Fund referred to in clause (23EA);
(II) a Credit Guarantee Fund Trust for Small Industries referred to in clause 23EB; and
(III) an Investor Protection Fund referred to in clause (23EC),
of section 10 of the Act;

3. Other definitions

10
FATCA CRS Self Declaration for Entities ANNEXURE II

(i) Related entity


An entity is a ‘related entity’ of another entity if either entity controls the other entity, or the two entities are under common control For this purpose,
control includes direct or indirect ownership of more than 50% of the votes and value in an entity.

(ii) Passive NFE

The term passive NFE means

(a) any non-financial entity which is not an active non-financial entity including a publicly traded corporation or related entity of a publicly traded company;
or
(b) an investment entity defined in clause 1(iii)(b) of these instructions.
(c) a withholding foreign partnership or withholding foreign trust;
(Note: Foreign persons having controlling interest in a passive NFE are liable to be reported for tax information compliance purposes)

(iii) Passive income

Thetermpassiveincome includes income by way of :


(1) Dividends,
(2) Interest
(3) Income equivalent to interest,
(4) Rents and royalties, other than rents and royalties derived in the active conduct of a business conducted, at least in part, by employees of the NFE
(5) Annuities
(6) The excess of gains over losses from the sale or exchange of financial assets that gives rise to passive income
(7) The excess of gains over losses from transactions (including futures, forwards, options and similar transactions) in any financial assets,
(8) The excess of foreign currency gains over foreign currency losses
(9) Net income from swaps
(10) Amounts received under cash value insurance contracts
Butpassive income will not include,in case of a non-financial entitythat regularly acts as a dealer in financial assets, any income from any transaction
entered into in the ordinary course of such dealer’s business as such a dealer.

(iv) Controlling persons

Controlling persons are natural persons who exercise control over an entityand includes a beneficial owner under sub-rule (3) of rule 9 of the Prevention of
Money-Laundering (Maintenance of Records) Rules, 2005.In the caseofatrust, the controlling person means thesettlor, the trustees, theprotector (ifany),
thebeneficiaries orclass ofbeneficiaries, and anyothernatural personexercisingultimateeffective control overthetrust. In the caseofalegalarrangement
otherthanatrust, controlling person means persons in equivalent orsimilarpositions.

Pursuant to guidelines on identification of Beneficial Ownership issued vide RBI circular no. DBOD.AML.BC. No.71/14.01.001/2012-13 dated January 18,
2013, persons (other than Individuals) are required to provide details of Beneficial Owner(s) (‘BO’). Accordingly, the Beneficial Owner means ‘Natural
11
FATCA CRS Self Declaration for Entities ANNEXURE II

Person’, who, whether acting alone or together, or through one or more juridical person, exercises control through ownership or who ultimately has a
controlling ownership interest of / entitlements to:
i. More than 25% of shares or capital or profits of the juridical person, where the juridical person is a company;
ii. More than 15% of the capital or profits of the juridical person, where the juridical person is a partnership; or
iii. More than 15% of the property or capital or profits of the juridical person, where the juridical person is an unincorporated association or
body of individuals.
Where the client is a trust, the financial institutionshall identify the beneficial owners of the client and take reasonable measures to verify the identity of such
persons, through the identity of the settler of the trust, the trustee, the protector, the beneficiaries with 15% or more interest in the trust and any other natural
person exercising ultimate effective control over the trust through a chain of control or ownership.
Where no natural person is identified the identity of the relevant natural person who holds the position of senior managing official.

(A) Controlling Person Type:


Code Sub-category
C01 CP of legal person-ownership
C02 CP of legal person-other means
C03 CP of legal person-senior managing official
C04 CP of legal arrangement-trust-settlor
C05 CP of legal arrangement--trust-trustee
C06 CP of legal arrangement--trust-protector
C07 CP of legal arrangement--trust-beneficiary
C08 CP of legal arrangement--trust-other
C09 CP of legal arrangement—Other-settlor equivalent
C10 CP of legal arrangement—Other-trustee equivalent
C11 CP of legal arrangement—Other-protector equivalent
C12 CP of legal arrangement—Other-beneficiary equivalent
C13 CP of legal arrangement—Other-other equivalent
C14 Unknown

(v) Specified U.S. person– A U.S person other than the following:

(a) a corporation the stock of which is regularly traded on one or more established securities markets;
(b) any corporation that is a member of the same expanded affiliated group, as defined in section 1471(e)(2) of the U.S. Internal Revenue Code, as a
corporation described in clause (i);
(c) the United States or any wholly owned agency or instrumentality thereof;
(d) any State of the United States, any U.S. Territory, any political subdivision of any of the foregoing, or any wholly owned agency or instrumentality of
any one or more of the foregoing;
(e) any organization exempt from taxation under section 501(a) of the U.S. Internal Revenue Code or an individual retirement plan as defined in section
12
FATCA CRS Self Declaration for Entities ANNEXURE II

7701(a)(37) of the U.S. Internal Revenue Code;


(f) any bank as defined in section 581 of the U.S. Internal Revenue Code;
(g) any real estate investment trust as defined in section 856 of the U.S. Internal Revenue Code;
(h) any regulated investment company as defined in section 851 of the U.S. Internal Revenue Code or any entity registered with the U.S. Securities and
Exchange Commission under the Investment Company Act of 1940 (15 U.S.C. 80a-64);
(i) any common trust fund as defined in section 584(a) of the U.S. Internal Revenue Code;
(j) any trust that is exempt from tax under section 664(c) of the U.S. Internal Revenue Code or that is described in section 4947(a)(1) of the U.S. Internal
Revenue Code;
(k) a dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is
registered as such under the laws of the United States or any State;
(l) a broker as defined in section 6045(c) of the U.S. Internal Revenue Code; or
(m) any tax-exempt trust under a plan that is described in section 403(b) or section 457(g) of the U.S. Internal Revenue Code.

(vi) Owner documented FFI

An FFI meets the following requirements:

(A) The FFI is an FFI solely because it is an investment entity;

(B) The FFI is not owned by or related to any FFI that is a depository institution, custodial institution, or specified insurance company;

(C) The FFI does not maintain a financial account for any nonparticipating FFI;

(D) The FFI provides the designated withholding agent with all of the documentation and agrees to notify the

withholding agent if there is a change in circumstances; and


(E) The designated withholding agent agrees to report to the IRS (or, in the case of a reporting Model 1 FFI, to the relevant foreign government or agency
thereof) all of the information described in or (as appropriate) with respect to any specified U.S. persons and (2). Notwithstanding the previous sentence, the
designated withholding agent is not required to report information with respect to an indirect owner of the FFI that holds its interest through a participating
FFI, a deemed-compliant FFI (other than an owner-documented FFI), an entity that is a U.S. person,an exempt beneficial owner, or an excepted NFE.

(vii) Direct reporting NFE

A direct reporting NFE means a NFE that elects to report information about its direct or indirect substantial U.S. owners to the IRS

(viii) Exemption code for U.S. persons

Code Sub-category
A An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section
7701(a)(37)

13
FATCA CRS Self Declaration for Entities ANNEXURE II

B The United States or any of its agencies or instrumentalities


C A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or
instrumentalities
D A corporation the stock of which is regularly traded on one or more established securities markets, as described
in Reg. section 1.1472-1(c)(1)(i)
E A corporation that is a member of the same expanded affiliated group as a corporation described in Reg. section
1.1472-1(c)(1)(i)
F A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts,
futures, forwards, and options) that is registered as such under the laws of the United States or any state
G A real estate investment trust
H A regulated investment company as defined in section 851 or an entity registered at all times during the tax year
under the Investment Company Act of 1940
I A common trust fund as defined in section 584(a)
J A bank as defined in section 581
K A broker
L A trust exempt from tax under section 664 or described in section 4947(a)(1)
M A tax exempt trust under a section 403(b) plan or section 457(g) plan

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