Fillable CRS Controlling Person Self-Certification Form (CRS - CP) (Hang Seng Bank)

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CRS Controlling Person Self-Certification Form (CRS - CP) (Hang Seng Bank)

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D620a-R3(YX) 1-8 01/20 E
Page 1/8
Why are we asking you to complete this form?
To help protect the integrity of tax systems, governments around the world are introducing a new information gathering and reporting requirement
for financial institutions. This is known as the Common Reporting Standard (‘the CRS’).
Under the CRS, we are required to determine where you are “tax resident” (this will usually be where you are liable to pay income taxes by reason
of residence in a jurisdiction). If you are tax resident outside the jurisdiction where your account is held, we may need to give our local tax authority
this information, along with information relating to your accounts. That may then be shared between different jurisdictions' tax authorities.
Completing this form will ensure that we hold accurate and up to date information about your tax residency.
If your circumstances change and any of the information provided in this form becomes incorrect, please let us know immediately and provide an
updated Self-Certification Form.
Who should complete the CRS Controlling Person Self-Certification Form?
When an account is held with Hang Seng Bank on behalf of a Passive Entity (for example certain trusts or investment vehicles) we need those
individuals identified as having ultimate control of the entity to complete a form. These individuals are termed “Controlling Persons”.
If you need to self-certify on behalf of an entity (which includes all businesses, trusts and partnerships), complete a ‘CRS Entity Self-Certification
Form’ (CRS-E). Similarly, if you are a personal banking customer or a sole trader, complete a ‘CRS Individual Self-Certification Form’ (CRS-I).
You can find these forms at http://bank.hangseng.com/1/2/crs.
For joint or multiple Controlling Persons, each individual will need to complete a copy of the form.
Even if you have already provided information in relation to the United States Government’s Foreign Account Tax Compliance Act (‘FATCA’), you
may still need to provide additional information for the CRS as this is a separate regulation.
If you are completing this form on behalf of a Controlling Person, please ensure that you let them know that you have done so and tell us in what
capacity you are signing in Part 5. For example you are completing the form under a power of attorney.
Where to go for further information?
If you have any questions about this form or these instructions, please visit: http://bank.hangseng.com/1/2/crs, contact your Relationship
Manager, visit a branch or contact 24-hour Business Partner Direct 2198 8000.
The Organisation for Economic Co-operation and Development (“OECD”) has developed the rules to be used by all governments participating in
the CRS and these can be found on the OECD’s Automatic Exchange of Information (“AEOI”) website, www.oecd.org/tax/automatic-exchange/.
If you have any questions on how to define your tax residency status, please visit the OECD website, www.oecd.org/tax/automatic-exchange/ or
speak to your tax advisor as we are not allowed to give tax advice.
You can find a list of definitions in the Appendix.
CRS Controlling Person Self-Certification Form (CRS - CP)
Please read these instructions before completing this form
>>OPS>BOS
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D620a-R3(YX) 2-8 01/20 E
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CRS Controlling Person Self-Certification Form
•
•
•
This is a self-certification form provided by a Controlling Person to Hang Seng Bank Limited for the purpose of automatic exchange of
financial account information. The data collected may be transmitted by Hang Seng Bank Limited to the Inland Revenue Department for
transfer to the tax authority of another jurisdiction.
A Controlling Person should report all changes in his/her tax residency status to Hang Seng Bank Limited.
All parts of the form must be completed (unless not applicable or otherwise specified). If space provided is insufficient, continue on
additional sheet(s). Information in fields/parts marked with an asterisk (*) are required to be reported by Hang Seng Bank Limited to the
Inland Revenue Department.
Important Notes:
Please complete parts 1-5 in BLOCK CAPITALS.
Part 1 – Identification of Controlling Person
A. Name of Controlling Person
Mr Mrs Ms Miss
Other
___________________________________________________________________________
Last Name or Surname(s)* First or Given Name* Middle Name(s)
ID Document No.
_______________________________________________________________________________________________________
ID Document Type HKID Passport Other:
___________________________________________
B. Current Residence Address
C. Mailing Address (Please complete if different to the current residence address)
Line 1
(e.g. Suite, Floor, Building,
Street, District)
Line 2
(e.g. City)*
Line 3
(e.g. Province/State)
Country*/Territory*
Postal Code/ZIP Code
Line 1
(e.g. Suite, Floor, Building,
Street, District)
Line 2
(e.g. City)
Line 3
(e.g. Province/State)
Country/Territory
Postal Code/ZIP Code
>>OPS>BOS
D. Date of Birth*
(DD/MM/YYYY)
Travel Document
D620a-R3(YX) 3-8 01/20 E
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Part 3 – Jurisdiction of Residence and Taxpayer Identification Number or its Functional Equivalent (“TIN”)*
Jurisdiction of Residence
Please complete the following table indicating (a) the jurisdiction of residence (including Hong Kong) where the Controlling Person is a
resident for tax purposes and (b) the Controlling Person’s TIN for each jurisdiction indicated. Indicate all (not restricted to three) the
jurisdictions of residence.
If the Controlling Person is tax resident in more than three jurisdictions, please use a separate sheet.
If the Controlling Person is a tax resident of Hong Kong, the TIN is the Hong Kong Identity Card Number.
If a TIN is unavailable, provide the appropriate reason A, B or C:
Reason A - The jurisdiction where the Controlling Person is a resident for tax purposes does not issue TINs to its residents.
Reason B - The Controlling Person is unable to obtain a TIN. (Please explain why the Controlling Person is unable to obtain a TIN if you
have selected this reason)
Reason C - TIN is not required. (Select this reason only if the authorities of the jurisdiction of residence do not require the TIN to be
disclosed.)
TIN
Enter Reason A, B or C
if no TIN is available
Please explain in the following boxes why you are unable to obtain a TIN if you selected Reason B above.
1
2
3
•
•
•
•
>>OPS>BOS
1
2
3
Part 2 – The Entity Account Holder(s) of which you are a Controlling Person
Name of the Entity Account Holder
1
2
3
Enter the name of the entity account holder of which you are a Controlling Person.
Entity
D620a-R3(YX) 4-8 01/20 E
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Part 4 – Type of Controlling Person
Type of Controlling Person
Entity (3)
>>OPS>BOS
Tick the appropriate box to indicate the type of Controlling Person for each entity stated in Part 2.
Type of Entity
Entity (1) Entity (2)
Individual who has a controlling ownership interest (i.e. more than
25% of issued share capital)
Individual who exercises control / is entitled to exercise control
through other means (i.e. more than 25% of voting rights)
Individual who holds the position of senior managing official /
exercises ultimate control over the management of the entity
Legal Person
Settlor
Trustee
Protector or enforcer
Beneficiary or member of the class of beneficiaries
Other (e.g. individual who exercises control over another entity being
the settlor / trustee / protector or enforcer / beneficiary)
Trust
Individual in a position equivalent / similar to settlor
Individual in a position equivalent / similar to trustee
Individual in a position equivalent / similar to protector or enforcer
Individual in a position equivalent / similar to beneficiary or member
of the class of beneficiaries
Other (e.g. individual who exercises control over another entity being
equivalent / similar to settlor / trustee / protector or enforcer /
beneficiary)
Legal
Arrangement
other than Trust
D620a-R3(YX) 5-8 01/20 E
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Part 5 – 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 Hang Seng Bank Limited (“Hang Seng Bank”) setting out how Hang Seng Bank may use and share the information supplied
by me.
I acknowledge and agree that (a) the information contained in this form is collected and may be kept by Hang Seng Bank for the purpose of
automatic exchange of financial account information, and (b) such information and information regarding the Controlling Person and any
Reportable Account(s) may be reported by Hang Seng Bank to the Inland Revenue Department of the Government of the Hong Kong Special
Administrative Region and exchanged with the tax authorities of another jurisdiction or jurisdictions in which the Controlling Person may be
resident for tax purposes pursuant to the legal provisions for exchange of financial account information provided under the Inland Revenue
Ordinance (Cap.112).
I certify that I am the Controlling Person, or am authorised to sign for the Controlling Person, of all the account(s) held by the entity Account
Holder to which this form relates and where I am not the Controlling Person.
I certify that where I have provided information regarding any other person (such as a Controlling Person or other Reportable Person to which
this form relates) that I will, within 30 days of signing this form, notify those persons that I have provided such information to Hang Seng Bank
and that such information may be provided to the Inland Revenue Department of the Government of the Hong Kong Special Administrative
Region and exchanged with the tax authorities of another jurisdiction or jurisdictions in which the person may be resident for tax purposes
pursuant to the legal provisions for exchange of financial account information provided under the Inland Revenue Ordinance (Cap.112).
WARNING: It is an offence under section 80(2E) of the Inland Revenue Ordinance if any person, in making a self-certification,
makes a statement that is misleading, false or incorrect in a material particular AND knows, or is reckless as to whether, the
statement is misleading, false or incorrect in a material particular. A person who commits the offence is liable on conviction to a
fine at level 3 (i.e. HK$10,000).
I declare that the information given and all statements made in this form and this declaration are, to the best of my knowledge and
belief, true, correct and complete.
I undertake to advise Hang Seng Bank 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, and to provide Hang Seng Bank with a
suitably updated Self-Certification and Declaration within 90 days of such change in circumstances.
Signature
X ____________________________________________________________
Print Name
Note: If you are not the Controlling Person 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.
Date(DD/MM/YYYY)
Capacity
>>OPS>BOS
In the event of any discrepancy or inconsistency between the English version and the Chinese version of this form, the English version shall
prevail.
*
D620a-R3(YX) 6-8 01/20 E
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“Account Holder”
The “Account Holder” is the person listed or identified as the holder of a financial account by the Financial Institution that maintains the account.
This is regardless of whether such person is a flow-through Entity. Thus, for example, if a trust or an estate is listed as the holder or owner of a
financial account, the trust or estate is the Account Holder, rather than the trustee or the trust’s owners or beneficiaries. Similarly, if a partnership
is listed as the holder or owner of a financial account, the partnership is the Account Holder, rather than the partners in the partnership.
A person, other than a Financial Institution, holding a financial account for the benefit or account of another person as agent, custodian, nominee,
signatory, investment advisor, intermediary, or legal guardian, is not treated as the Account Holder. In these circumstances that other person is
the Account Holder. For example in the case of a parent/child relationship where the parent is acting as a legal guardian, the child is regarded as
the Account Holder.
With respect to a jointly held account, each joint holder is treated as an Account Holder.
“Active NFE”
An NFE is an Active NFE if it meets any of the criteria listed below. In summary, those criteria refer to:
An entity will be classified as Active NFE if it meets any of the following criteria:
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
“Control”
“Control” over an Entity is generally exercised by the natural person(s) who ultimately has a controlling ownership interest (typically on the basis
of a certain percentage (e.g. more than 25%)) in the Entity. Where no natural person(s) exercises control through ownership interests, the
Controlling Person(s) of the Entity will be the natural person(s) who exercises control of the Entity through other means. Where no natural
person(s) is/are identified as exercising control of the Entity through ownership interests, the Controlling Person of the Entity is deemed to be the
natural person who holds the position of senior managing official or exercises ultimate control over the management of the Entity.
Appendix
Definitions
>>OPS>BOS
•
•
•
•
•
•
•
•
Active NFEs by reason of income and assets;
Publicly traded NFEs;
Governmental Entities, International Organisations, Central Banks, or their wholly owned Entities;
Holding NFEs that are members of a nonfinancial group;
Start-up NFEs;
NFEs that are liquidating or emerging from bankruptcy;
Teasury centres that are members of a nonfinancial group; or
Non-profit NFEs.
less than 50% of the NFE’s gross income for the preceding calendar year or other appropriate reporting period is passive income and less
than 50% of the assets held by the NFE during the preceding calendar year or other appropriate reporting period are assets that produce or
are held for the production of passive income;
the stock of the NFE is regularly traded on an established securities market or the NFE is a Related Entity of an Entity the stock of which is
regularly traded on an established securities market;
the NFE is a governmental Entity, an international organisation, a central bank, or an Entity wholly owned by one or more of the foregoing;
substantially all of the activities of the NFE consist 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 does
not qualify for this status if the Entity functions (or holds itself out) 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;
the NFE is not yet operating a business and has no prior operating history, (a “start-up NFE”) but is investing capital into assets with the intent
to operate a business other than that of a Financial Institution, provided that the NFE does not qualify for this exception after the date that is
24 months after the date of the initial organisation of the NFE;
the NFE was not a Financial Institution in the past five years, and is in the process of liquidating its assets or is reorganising with the intent to
continue or recommence operations in a business other than that of a Financial Institution;
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; or
the NFE meets all of the following requirements (a “non-profit NFE”) :
(i)
(ii)
(iii)
(iv)
(v)
it is established and operated in its jurisdiction of residence exclusively for religious, charitable, scientific, artistic, cultural, athletic, or
educational purposes; or it is established and operated in its jurisdiction of residence and it is a professional organisation, business
league, chamber of commerce, labour organisation, agricultural or horticultural organisation, civic league or an organisation operated
exclusively for the promotion of social welfare;
it is exempt from income tax in its jurisdiction of residence;
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 jurisdiction 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 jurisdiction 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 organisation, or escheat to the government of the
NFE’s jurisdiction of residence or any political subdivision.
D620a-R3(YX) 7-8 01/20 E
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“Controlling Person(s)”
“Controlling Persons” are the natural person(s) who exercise control over an Entity. In the case of a trust, the Controlling Person(s) are the
settlor(s), the trustee(s), the protector(s) / enforcer(s) (if any), the beneficiary(ies) or class(es) of beneficiaries, or any other natural person(s)
exercising ultimate effective control over the trust (including through a chain of control or ownership). The settlor(s), the trustee(s), the
protector(s) / enforcer(s) (if any), and the beneficiary(ies) or class(es) of beneficiaries, must always be treated as Controlling Persons of a trust,
regardless of whether or not any of them exercises control over the activities of the trust.
Where the settlor, trustee, protector / enforcer or beneficiary of a trust are themselves Entities then the Controlling Persons of the settlor, trustee,
protector / enforcer or beneficiary must be treated as Controlling Persons of the trust.
In the case of a legal arrangement other than a trust, “Controlling Person(s) means persons in equivalent or similar positions to those of a trust.
“Custodial Institution”
The term “Custodial Institution” means any Entity that holds, as a substantial portion of its business, financial assets for the account of others.
This is where the Entity’s gross income attributable to the holding of financial assets and related financial services equals or exceeds 20% of the
Entity’s gross income during the shorter of: (i) the three-year period that ends on 31 December (or the final day of a non-calendar year accounting
period) prior to the year in which the determination is being made; or (ii) the period during which the Entity has been in existence.
"Depository Institution"
The term “Depository Institution” means an authorized institution as defined by section 2(1) of the Banking Ordinance (Cap. 155) or any Entity
that accepts deposits in the ordinary course of a banking or similar business.
“Entity”
The term “Entity” means a legal person or a legal arrangement, such as a corporation, organisation, partnership, trust or foundation. This term
covers any person other than an individual (i.e. a natural person).
“Financial Institution”
The term “Financial Institution” means a “Custodial Institution”, a “Depository Institution”, an “Investment Entity”, or a “Specified Insurance
Company”.
“Investment Entity”
The term “Investment Entity” means:
(a) a corporation licensed under the Securities and Futures Ordinance (Cap. 571) to carry out one or more of the following regulated activities:
(b) an institution registered under the Securities and Futures Ordinance (Cap. 571) to carry out one or more of the following regulated activities:
(c) a collective investment scheme authorized under the Securities and Futures Ordinance (Cap. 571);
(d) an Entity that primarily conducts as a business one or more of the following activities or operations for or on behalf of a customer:
(e)
“Investment Entity managed by another Financial Institution and located in a Non-Participating Jurisdiction”
The term “Investment Entity that is managed by another Financial Institution and located in a Non-Participating Jurisdiction” means any Entity the
gross income of which is primarily attributable to investing, reinvesting, or trading in financial assets if the Entity is (i) managed by a Financial
Institution and (ii) not a Participating Jurisdiction Financial Institution.
“Investment Entity managed by another Financial Institution”
An Entity is “managed by” another Entity if the managing Entity performs, either directly or through another service provider on behalf of the
managed Entity, any of the activities or operations described in paragraph (d) above in the definition of “Investment Entity”.
An Entity only manages another Entity if it has discretionary authority to manage the other Entity’s assets (either in whole or part). Where an Entity
is managed by a mix of Financial Institutions, NFEs or individuals, the Entity is considered to be managed by another Entity that is a Depository
Institution, a Custodial Institution, a Specified Insurance Company, or an Investment Entity described in (a), (b), (c) or (d) above, if any of the
managing Entities is such another Entity.
“NFE”
An “NFE” is any Entity that is not a Financial Institution.
Appendix
>>OPS>BOS
(i)
(ii)
(iii)
(iv)
dealing in securities;
trading in futures contracts;
leveraged foreign exchange trading;
asset management;
(i)
(ii)
(iii)
dealing in securities;
trading in futures contracts;
asset management;
(i)
(ii)
(iii)
trading in money market instruments (cheques, bills, certificates of deposit, derivatives, etc.); foreign exchange; exchange, interest rate
and index instruments; transferable securities; or commodity futures trading;
individual and collective portfolio management; or
otherwise investing, administering, or managing Financial Assets or money on behalf of other entity or individual. Such activities or
operations do not include rendering non-binding investment advice to a customer.
the second type of “Investment Entity” (“Investment Entity managed by another Financial Institution”) is any Entity the gross income of which
is primarily attributable to investing, reinvesting, or trading in financial assets where the Entity is managed by another Entity that is a Depository
Institution, a Custodial Institution, a Specified Insurance Company, or an Investment Entity described in (a), (b), (c) or (d) above.
D620a-R3(YX) 8-8 01/20 E
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“Participating Jurisdiction”
A “Participating Jurisdiction” means a jurisdiction outside Hong Kong that is specified in Part 2 of Schedule 17E of the Inland Revenue Ordinance
(Cap. 112).
“Participating Jurisdiction Financial Institution”
The term “Participating Jurisdiction Financial Institution means (i) any Financial Institution that is tax resident in a Participating Jurisdiction, but
excludes any branch of that Financial Institution that is located outside of that jurisdiction, and (ii) any branch of a Financial Institution that is not
tax resident in a Participating Jurisdiction, if that branch is located in such Participating Jurisdiction.
“Passive NFE”
A “Passive NFE” means any: (i) NFE that is not an Active NFE; and (ii) Investment Entity located in a Non-Participating Jurisdiction and managed
by another Financial Institution.
“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 vote and value in an Entity.
“Resident for tax purposes”
Generally, an Entity will be resident for tax purposes in a jurisdiction if, under the laws of that jurisdiction(including tax conventions), it pays or
should be paying tax therein by reason of his domicile, residence, place of management or incorporation, or any other criterion of a similar nature,
and not only from sources in that jurisdiction. An Entity such as a partnership, limited liability partnership or similar legal arrangement that has no
residence for tax purposes shall be treated as resident in the jurisdiction in which its place of effective management is situated. A trust is treated
as resident where one or more of its trustees is resident. For additional information on tax residence, please talk to your tax advisor or refer to the
OECD Automatic Exchange Portal at the following link:
http://www.oecd.org/tax/automatic-exchange/crs-implementation-and-assistance/tax-residency/.
“Specified Insurance Company"
The term “Specified Insurance Company” means any 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.
“TIN” (including “functional equivalent”)
The term “TIN” means Taxpayer Identification Number or a functional equivalent in the absence of a TIN. A TIN is a unique combination of letters
or numbers assigned by a jurisdiction to an individual or an Entity and used to identify the individual or Entity for the purposes of administering the
tax laws of such jurisdiction. Further details of acceptable TINs can be found at the OECD Automatic Exchange Portal at the following link:
http://www.oecd.org/tax/automatic-exchange/crs-implementation-and-assistance/tax-identification-numbers/
Some jurisdictions do not issue a TIN. However, these jurisdictions often utilise some other high integrity number with an equivalent level of
identification (a “functional equivalent”).
Examples of that type of number include:
(a) (for individuals) a social security/insurance number, citizen/personal identification/service code/number, and resident registration number.
(b) (for Entities) a Business/company registration code/number.
Appendix
>>OPS>BOS
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CRS Controlling Person Self-Certification Form (CRS - CP) (Hang Seng Bank)

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