Fill - Free fillable CRS Entity Self-Certification Form (CRS

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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 corporate 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 Entity Self-Certification Form?

Business banking customers (which includes all businesses, trusts and partnerships except sole traders) should complete this form.

If you are a personal banking customer or a sole trader, complete a “CRS Individual Self-Certification Form” (CRS-I). Similarly, if you are a

controlling person of an entity, complete a “CRS Controlling Person Self-Certification Form” (CRS-CP). You can find these forms at

http://bank.hangseng.com/1/2/crs.

For joint account holders, each account holder 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.

Please tell us in what capacity you are signing in Part 5. For example you may be an authorised officer of the business or a trustee.

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 a professional tax advisor as we are not allowed to give tax advice.

You can find a list of definitions in the Appendix.

CRS Entity Self-Certification Form (CRS - E)

Please read these instructions before completing this form

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D621a-R3(YX) 2-8 01/20 E

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CRS Entity Self-Certification Form

•

This is a self-certification form provided by an Account Holder 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.

An Account Holder should report all changes in its 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 Entity Account Holder

(For joint or multiple account holders, please complete a separate form for each entity account holder.)

A. Customer Information

Legal Name of Entity / Branch*

Jurisdiction of Incorporation or Organization

Registration Number

B. Current Business Address

C. Mailing Address (Please complete if different to the current business 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

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D621a-R3(YX) 3-8 01/20 E

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Part 3 – Controlling Persons (Please complete this part if the entity Account Holder is a Passive NFE)

Indicate the name of all controlling person(s) of the Account Holder in the table below. If no natural person exercises control over an entity

which is a legal person, the controlling person will be the individual holding the position of senior managing official.

Please complete CRS Controlling Person Self-Certification Form for each controlling person.

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Part 2 – Entity Type

Tick one of the appropriate boxes and provide the relevant information.

Financial Institution

Custodial Institution, Depository Institution or Specified Insurance Company

Investment Entity, except an investment entity that is managed by another financial institution (e.g. with discretion

to manage the entity’s assets) and located in a non-participating jurisdiction

Active NFE

NFE the stock of which is regularly traded on

________________________________________________________

Related entity of

________________________________________________________________________________

___________________________________________________________________________

, the stock of

which is regularly traded on

______________________________________________________________________

_____________________________________________________

, which is an established securities market.

NFE is a governmental entity, a central bank, or an entity wholly owned by one or more the foregoing entities

Active NFE other than the above

Passive NFE

Investment entity that is managed by another financial institution and located in a non-participating jurisdiction

NFE that is not an active NFE

_____________________________________________________

, which is an established securities market.

NFE is an international organization (for example the United Nations or NATO) or an entity wholly owned by one

or more international organizations.

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Part 4 – 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 Account Holder is a

resident for tax purpose and (b) the Account Holder’s TIN for each jurisdiction indicated. Indicate all (not restricted to three) jurisdictions

of residence.

If the Account Holder is tax resident in more than three jurisdictions, please use a separate sheet.

If the Account Holder is a tax resident of Hong Kong, the TIN is the Hong Kong Business Registration Number.

If the Account Holder is not a tax resident in any jurisdiction (e.g. fiscally transparent), indicate the jurisdiction in which its place of effective

management is situated.

If a TIN is unavailable, provide the appropriate reason A, B or C:

Reason A - The jurisdiction where the Account Holder is a resident for tax purposes does not issue TINs to its residents.

Reason B - The Account Holder is unable to obtain a TIN. Explain why the Account holder 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.

•

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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 Account Holder 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 Account Holder 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 authorised to sign for the Account Holder in respect of all the account(s) to which this form relates.

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).

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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 Account

Holder identified in Part 1 of this form or causes the information contained herein to become incorrect (including any changes to the

information on controlling persons identified in Part 3), 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: Please indicate the capacity in which you are signing the form (for example “Authorised Officer”). If signing under a power of attorney please

also attach a certified copy of the power of attorney.

Date(DD/MM/YY)

Capacity

In the event of any discrepancy or inconsistency between the English version and the Chinese version of this form, the English version shall

prevail.

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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

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•

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.

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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:

(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

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(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.

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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

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