Fillable Introduction The automatic exchange of financial account information (Standard Chartered)

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Introduction The automatic exchange of financial account information (Standard Chartered)

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Introduction

The automatic exchange of financial account information (AEOI) regime is based on the Common Reporting Standard (CRS),

an internationally-agreed standard developed by the Organisation of Economic Co-operation and Development (OECD) to

combat tax evasion. AEOI refers to the regular exchange of financial account information between jurisdictions, the purpose

of which is to deter and detect tax evasion by taxpayers through the use of offshore bank accounts.

Standard Chartered PLC and its subsidiaries and affiliates (Standard Chartered) must comply with the relevant requirements

in all countries or jurisdictions in which Standard Chartered operates and AEOI requirements are in effect.

In order to comply with the relevant requirements to enable AEOI, Standard Chartered must collect certain information and/or

documentation from clients to establish their tax residence and (if applicable) classification status. In certain circumstances,

Standard Chartered may be required to report this information to relevant tax authorities. This information then may be

exchanged or reported to relevant tax authorities in other countries or jurisdictions, in accordance with applicable law.

This is a Self-Certification that Standard Chartered is requesting you to complete to establish your tax residence and (if

applicable) classification status. In certain circumstances, for example, where required by regulations/guidance implementing

under Intergovernmental Agreements (IGAs) between relevant countries or jurisdictions and the United States (U.S.), this

Self-Certification also may be used to document your tax status under the U.S. Foreign Account Tax Compliance Act (FATCA)

provisions. FATCA came into effect on 1 July 2014 and seeks to prevent tax evasion by U.S. Persons through the use of

accounts held outside the U.S.

The Self-Certification and explanatory notes are not a substitute for understanding AEOI under CRS or FATCA. The Bank

does not, and cannot, provide tax or legal advice. If you have any questions about this Self-Certification, AEOI under CRS or

FATCA, please consult your tax, legal, or other professional advisor.

Please complete this Self-Certification if you are an individual (including a sole proprietor) Account Holder. An “Account

Holder” may include an individual who is a settlor or beneficiary of a trust administered by a professional corporate trustee or

a trust company. For further information, refer to the definition of “Account Holder” on page 4.

For joint or multiple Account Holders, use a separate Form for each Account Holder. If you are providing a Self-Certification

for an entity account holder or are a Controlling Person of an entity account holder, do not use this Self-Certification. Instead,

fill in the ‘CRS Self-Certification – Entity’.

If you are a U.S. Person, you must complete and provide a Form W-9 issued by the U.S. Internal Revenue Service, in addition

to this Self-Certification.

Self-Certication – Individual

Self Certication - Individual (09-2018) Page 1

Self-Certication – Individual

Please complete Parts 1 to 3 in BLOCK LETTERS and read the Instructions on how to complete this Self-Certication and

Denitions on page 4.

Part 1

Identication of Individual Account Holder

A) Name of the Individual who is the Account Holder B) Date of Birth

Title:

DD-MM-YYYY:

Surname(s): C) Place of Birth

First or Given Name: Town or City of Birth:

Middle Name(s): Country/Jurisdiction of Birth:

D) Current Residence Address E) Mailing Address (complete

only

if dierent from Section D)

Address Line 1: Address Line 1:

Address Line 2: Address Line 2:

City/Town: City/Town:

Province/State/County: Province/State/County:

Postal Code/ZIP Code: Postal Code/ZIP Code:

Country/Jurisdiction: Country/Jurisdiction:

F) Gender* G) Country(ies) or Jurisdiction(s) of Citizenship*

□

Male

□ Female

H) Identication Number*

□

Others

*Complete elds F, G, and H only if the Account Holder maintains a Financial Account in India.

Self Certication - Individual (09-2018) Page 2

Self-Certication – Individual

Part 2

Tax Residence Information

Please complete the following table indicating (i) the country/jurisdiction where the Account Holder is resident for tax purposes

and (ii) the Account Holder’s Taxpayer Identification Number or functional equivalent (hereafter referred to as TIN) for each

country/jurisdiction indicated. If the Account Holder is a resident for tax purposes in more than three countries/jurisdictions, please

use a separate sheet. All countries/jurisdictions of tax residence must be included, regardless of whether the country/jurisdiction

has an IGA or has adopted the CRS.

If no TIN or functional equivalent is provided, please indicate Reason A, B or C where appropriate:

• Reason A: Country/Jurisdiction does not issue TINs to its residents.

• Reason B: Country/Jurisdiction issues TINs, but the Account Holder is unable or not required to obtain a TIN (please

explain why the Account Holder is unable or not required to obtain a TIN).

• Reason C: No TIN is required. Country/Jurisdiction issues TINs but the country/jurisdiction does not require Financial

Institutions to collect TINs from its residents.

More details are available in the Instructions to this Self-Certication.

No. Country or Jurisdiction of Tax Residence TIN

If no TIN or functional equivalent is provided,

indicate Reason A, B or C

If Reason B is selected above, explain why the Account Holder is unable or not required to obtain a TIN in the

corresponding row below

Self Certication - Individual (09-2018) Page 3

Part 3

Declaration and Signature

I understand that the information supplied by me is subject to the terms and conditions governing the account(s) maintained

with Standard Chartered PLC and its subsidiaries and aliates to which this Self-Certication relates.

I acknowledge that the information contained in this Self-Certication 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/these account(s)

is/are maintained and exchanged with tax authorities of another country/jurisdiction or countries/jurisdictions in which this

Account Holder may be a tax resident, pursuant to a bilateral or multilateral agreements between governments to exchange

nancial account information.

I certify that I am the Account Holder (or am authorised to sign for the Account Holder) of all of the account(s) to which this

Self-Certication 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 notify the recipient of this Self-Certication within 30 days of any change in circumstances which aects the

tax residency status of the Account Holder or which causes the information contained herein to become incorrect, and to

submit a suitably updated Self-Certication and Declaration within 30 days of such change in circumstances and to provide

any additional information as may be required by Standard Chartered and/or applicable law.

Please note that in providing this Self-Certication, a statement that is false, misleading, or incorrect may be

regarded as an oence and, therefore may be subject to penalties under relevant law or regulation.

Self-Certication – Individual

Sign Here

Date (DD-MM-YYYY)

Signature of Account Holder (or individual authorised to

sign for the Account Holder)

Print Full Name

Capacity of the individual authorised to sign for the Account Holder

Self Certication - Individual (09-2018) Page 4

Self-Certication – Individual

Denitions

The following is a non-exhaustive list of selected terms that is intended as a

guide to assist you in completing this Self-Certification. Should you have any

questions, please contact your tax, legal, and/or other professional advisor.

• Account Holder: The term ‘Account Holder’ means the person listed or

identied as the holder of a Financial Account. A person, other than a Financial

Institution, holding a Financial Account for the benet of another person as

an agent, a custodian, a nominee, a signatory, an investment advisor, an

intermediary, or as a 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.

Subject to applicable regulations and guidance, an Account Holder may

include an individual who is a settlor, beneciary, protector, or other person

holding an equity or debt interest of a trust administered by a professional

corporate trustee or a trust company, i.e., a trustee that, as its primary business,

invests, administers, or manages the assets for trusts (or other customers). An

‘equity interest’ may be considered to be held in the case of a trust that is a

Financial Institution, by any person treated as a settlor or beneciary of all or

a portion of the trust, or any other natural person exercising ultimate eective

control over the trust.

• Financial Account: A Financial Account is an account maintained by a

Financial Institution and is either a depository account, a custodial account, an

equity and debt interest in certain investment entities, a cash value insurance

contract, or an annuity contract.

• Participating Jurisdiction:

A jurisdiction –

(i) with which an agreement is in place pursuant to which it will provide the

specied information under CRS as required on the automatic exchange

of nancial account information, and

(ii) which is identied in a published list.

• Reportable Account: A Reportable Account is a Financial Account that is

maintained by a Reporting Financial Institution and that, pursuant to due diligence

procedures consistent with CRS, FATCA and any applicable IGA, has been

identied as an account that is held by one or more persons that are U.S. Persons

or Reportable Persons with respect to another Jurisdiction or by a Passive NFE with

one or more Controlling Persons that are U.S. Persons or Reportable Persons with

respect to another Jurisdiction.

•

Reportable Jurisdiction: A Reportable Jurisdiction is a Participating

Jurisdiction with which an obligation to provide nancial account information

is in place and that is identied in a published list.

•

Reportable Person: A Reportable Person is an Individual who is tax resident in

a Reportable Jurisdiction under the laws of that jurisdiction. A Reportable Person

may include a beneciary of a trust if such Reportable Person has the right to

receive directly or indirectly (for example, through a nominee), a mandatory

distribution or may receive, directly or indirectly, a discretionary distribution from a

trust that is a Financial Institution. Dual resident individuals may rely on tiebreaker

rules contained in tax conventions (if applicable) to solve cases of double

residence for purposes of determining their residence for tax purposes.

•

Resident for tax purposes: Each country/jurisdiction has its own rules for

dening tax residence, and certain countries/jurisdictions have provided

information on how to determine whether an individual is tax resident in the

country/jurisdiction on the OECD automatic exchange of information portal.

For additional information on tax residence, please talk to your legal, tax,

or other professional advisor or refer to the OECD automatic exchange of

information portal on tax residency: http://www.oecd.org/tax/automatic-

exchange/crs-implementation-and-assistance/tax-residency/#d.en.347760.

•

Taxpayer Identication Number (TIN): TIN 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: http://www.

oecd.org/tax/automatic-exchange/crs-implementation-and-assistance/tax-

identication-numbers/#d.en.347759. Some jurisdictions do not issue a TIN.

However, these jurisdictions often utilise some other high integrity number

with an equivalent level of identication (a ‘functional equivalent’). Examples

of that type of number include, for individuals, a social security/insurance

number, citizen/personal identication/service code/number, and resident

registration number.

•

U.S. Person: A U.S. Person is dened in section 7701(a) (30) of the U.S. Internal

Revenue Code and includes an individual who is a citizen or resident of the U.S.

Instructions

Part 1 Identication of Individual Account Holder

A) Name of the Individual who is the Account Holder

Enter the

full name of the individual identified as the Account Holder

. This is a

mandatory eld.

B) Date of Birth: Enter the Account Holder’s date of birth. Use the following

format to input the Account Holder’s information DD-MM-YYYY. This is a

mandatory eld.

C) Place of Birth: Enter the Account Holder’s place of birth by including the

town, city, and country or jurisdiction of birth, where applicable.This is a

mandatory eld.

D) Current Residence Address: Enter the Account Holder’s current

residence address. This is a mandatory eld.

E) Mailing Address: Enter the Account Holder’s mailing address only if it is

dierent from the Current Residence Address.

F) Gender*: Check the relevant box indicating the Account Holder’s gender.

G) Country(ies)/Jurisdiction(s) of Citizenship*: Enter the Account

Holder’s country(ies) or jurisdiction(s) of citizenship. In the case of multiple

countries or jurisdictions of citizenship, all citizenships must be listed.

If the Account Holder is a U.S. citizen, a Form W-9 must be provided in

addition to this Self Certication.

H) Identication Number*: Enter the Account Holder's identication number.

*Complete elds F, G, and H only if the Account Holder maintains a Financial Account in India.

Please refer to the Denitions provided in this Self-Certication for an explanation of an Account Holder.

Part 2 Tax Residence Information

Please complete the table indicating (i) the country(ies)/jurisdiction(s) where

the Account Holder is/are Resident for tax purposes and (ii) the Account

Holder’s TIN for each country/jurisdiction indicated. Please refer to the

Denitions provided in this Self-Certication for an explanation on “Resident

for tax purposes”.

The requirement to pay tax in a particular country/jurisdiction does not

necessarily signify tax residence in that country/jurisdiction; it is possible to

have to pay tax in a country/jurisdiction in which one is not tax resident, and

not to have to pay tax in a country in which one is tax resident. Whether a

person is tax resident in a particular country/jurisdiction depends on whether

that person meets the denition of a tax resident under the tax laws of that

country/jurisdiction. For more information on tax residence, please consult

your tax advisor or refer to the information at OECD automatic exchange

of information portal at http://www.oecd.org/tax/automatic-exchange/crs-

implementation-and-assistance/tax-residency/#d.en.347760.

If a TIN is unavailable, please indicate only one of the following reasons:

Reason (A): Country/Jurisdiction does not issue TINs.

Reason (B): Country/Jurisdiction issues TINs and requires Financial

Institutions to collect TINs, but the Account Holder is unable or not required to

obtain a TIN. Please provide an explanation as to why the Account Holder is

unable or not required to obtain a TIN in the table.

Reason (C): No TIN is required. Country/Jurisdiction issues TINs but the

country/jurisdiction does not require Financial Institutions to collect TINs from

its residents. This is a mandatory eld.

Part 3 Declaration and Signature

Declaration and Signature: The Self-Certication must be signed and dated

by the Account Holder. If this Self-Certication is completed by an Individual

authorised to sign on behalf of the Account Holder, please indicate the

capacity in which the authorised Individual is signing the Self-Certication.

This is a mandatory eld.

Capacity: An Individual authorised to sign on behalf of the Account Holder

must state the capacity in which they are signing. If this Self-Certication is

completed by an agent acting under a duly authorised power of attorney,

the Form must be accompanied by the power of attorney in proper Form

specically authorising the agent to represent the Account Holder in making,

executing and presenting the Self-Certification. If the Self-Certification is

completed by the Account Holder, leave the eld blank.

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