1
CONFIRMATION OF
RESIDENTIAL ADDRESS
SERVICING
Please complete this form using
BLOCK CAPITALS and send it
to
csc@rl360.com
or fax it to:
+44 (0)1624 677336
Alternatively you can post it to:
RL360, International House, Cooil Road,
Douglas, Isle of Man, IM2 2SP
We will accept emailed or faxed scans of
instruc
tions. However, we reserve the
right to request original documents in
some circumstances, so these must be
retained in your records.
RL360 must have evidence of the
residential address of all applicants.
In the event that no acceptable
document can be provided as evidence
of your residential address or you
are submitting an employer’s letter
as verification of address, you must
complete this form which must be
signed by you as the applicant(s) along
with your financial adviser.
RL360 will also require a suitably
certified copy of your residence visa, if
you are not submitting an employer’s
letter as verification of address.
Note
Specified US Person means a US citizen
or tax resident individual who has a US
residential/correspondence address
or who either holds a US Passport, a
US Green Card or who was born in the
US and has not yet renounced their US
citizenship. More information on US
FATCA can be found at: www.irs.gov/
Businesses/Corporations/Foreign-
Account-Tax-Compliance-Act-FATCA
APPLICANT(S) DETAILS
Surname
First name
Country of birth
Country or countries
of residence
Tax Identification Number (TIN)
If unavailable, provide a functional equivalent (eg National Insurance Number, Social Security Number, resident registration number)
Are you a Specified US Person?
Yes
No
Current residential
address
Please provide a
written physical
description of the
location of your
residential address
along with the
directions.
