Fill - Free fillable CRS–I - Individual Tax Residency Self-Certification Form PDF form

INSTRUCTIONS

CRS Individual Self-Certification Form

Please read these instructions before completing the form

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). If you are tax resident outside the country where your account is held

we may need to give the national tax authority this information, along with information relating to your

accounts. That may then be shared between different countries’ 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.

Who should complete the CRS Individual Self-Certification Form?

Personal banking customers or sole traders should complete this form.

If you need to self-certify on behalf of an entity (which includes businesses, trusts and partnerships),

complete an ‘Entity Tax Residency Self-Certiﬁcation Form’ (CRS-E). Similarly, if you are a controlling

person of an entity, complete a ‘Controlling Person Tax Residency Self-Certiﬁcation Form’ (CRS-CP).

You can ﬁnd these forms at: www.crs.hsbc.com

For joint account holders, 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 someone else, please ensure that you let them know that you

have done so and tell us in what capacity you are signing in Part 3. For example, you might be completing

this form as a custodian or nominee of an account, under a Power of Attorney or as a legal guardian on

behalf of an account holder who is a minor.

Where to go for further information

If you have any questions about this form or these instructions please visit: www.crs.hsbc.com

contact your Relationship Manager, visit a branch or call us.

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

or speak to a professional tax adviser as we are not allowed to give tax advice.

You can ﬁnd a list of deﬁnitions in the Appendix.

Individual Tax Residency CRS – I

Self-Certification Form

Part 1

Identification of Individual Account Holder

A. Name of Account Holder:

Family Name or

Surname(s)

Title Mr Mrs Ms Miss Other

First or Given

name(s)

Middle Name(s)

B. Current Residence Address:

Line 1 House/Apt/Suite

Name, Number, Street)

Line 2 Town / Cit y

Province/County/State

Country Postal Code / ZIP code

C. Mailing Address: (please only complete if different from the address shown in Section B above)

Line 1 House/Apt/Suite

Name, Number, Street)

Line 2 Town / Cit y

Province/County/State

Country Postal Code / ZIP code

D. Date of birth

D M M Y Y Y Y

E. Place of birth

Town or City of Birth

Country of Birth

Please complete Parts 1– 3 in BLOCK CAPITALS

Part 2

Country of Residence for Tax Purposes and related Taxpayer Identification Number

or functional equivalent (“TIN”) (See Appendix)

Please complete the following table indicating:

(i) where the Account Holder is a tax resident;

(ii) the Account Holder’s TIN for each country indicated.

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

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

Reason A The country where the Account Holder is liable to pay tax does not issue TINs

to its residents

Reason B The Account Holder is otherwise unable to obtain a TIN or equivalent number

(Please explain why you are unable to obtain a TIN in the below table if you have

selected this reason)

Reason C No TIN is required. (Note. Only select this reason if the authorities of the country of

tax residence entered below do not require the TIN to be disclosed)

Country of tax residence TIN

If no TIN available enter

Reason A, B or C

Please explain in the following boxes why you are unable to obtain a TIN if you selected Reason B above.

Individual Tax Residency Self-Certification Form Please complete Parts 1– 3 in BLOCK CAPITALS

Part 3

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 HSBC setting out how HSBC may use and share the information supplied by me.

I acknowledge that the information contained in this form and information regarding the Account Holder and any

Reportable Account(s) may be provided to the tax authorities of the country in which this account(s) is/are maintained

and exchanged with tax authorities of another country or countries in which the Account Holder may be tax resident

pursuant to intergovernmental agreements to exchange ﬁnancial account information.

I certify that I am the Account Holder (or am authorised to sign for the Account Holder) 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 HSBC and that such information may be provided to the tax authorities of the country

in which the account(s) is/are maintained and exchanged with tax authorities of another country or countries in which the

person may be tax resident pursuant to intergovernmental agreements to exchange ﬁnancial account information.

I declare that all statements made in this declaration

are, to the best of my knowledge and belief, correct

and complete.

I undertake to advise HSBC 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 HSBC with a suitably updated self-certification and

Declaration within 90 days of such change in circumstances.

Signature:

Print name:

Date

D D M M Y Y Y Y

Note: If you are not the Account Holder 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.

Capacity:

Individual Tax Residency Self-Certification Form Please complete Parts 1– 3 in BLOCK CAPITALS

click to sign

signature

click to edit

Appendix – Definitions

‘Account Holder’ The term ‘Account Holder’ means the person listed or identiﬁed as the holder of a Financial Account.

A person, other than a Financial Institution, holding a Financial Account for the beneﬁt 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.

‘Controlling Person’ This is a natural person who exercises control over an entity. Where an entity Account

Holder is treated as a Passive Non-Financial Entity (‘NFE’) then a Financial Institution must determine whether such

Controlling Persons are Reportable Persons. This deﬁnition corresponds to the term ‘beneﬁcial owner’ as described in

Recommendation 10 of the Financial Action Task Force Recommendations (as adopted in February 2012).

If the account is maintained for an entity of which the individual is a Controlling Person, then the

‘Controlling Person tax residency Self-Certification’ form should be completed instead of this form.

‘Entity’ The term ‘Entity’ means a legal person or a legal arrangement, such as a corporation, organisation, partnership,

trust or foundation.

‘Financial Account’ A Financial Account is an account maintained by a Financial Institution and includes: Depository

Accounts; Custodial Accounts; Equity and debt interest in certain Investment Entities; Cash Value Insurance Contracts;

and Annuity Contracts.

‘Participating Jurisdiction’ A Participating Jurisdiction means a jurisdiction with which an agreement is in place

pursuant to which it will provide the information required on the automatic exchange of ﬁnancial account information set

out in the Common Reporting Standard.

‘Reportable Account’ The term ‘Reportable Account’ means an account held by one or more Reportable Persons or by

a Passive NFE with one or more Controlling Persons that is a Reportable Person

‘Reportable Jurisdiction’ A Reportable Jurisdiction is a jurisdiction with which an obligation to provide ﬁnancial account

information is in place.

‘Reportable Person’ A Reportable Person is deﬁned as an individual who is tax resident in a Reportable Jurisdiction

under the tax laws of that jurisdiction. Dual resident individuals may rely on the tiebreaker rules contained in tax

conventions (if applicable) to solve cases of double residence for purposes of determining their residence for tax

purposes.

‘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 following link:

http://www.oecd.org/tax/transparency/automaticexchangeofinformation.htm

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, for individuals, a

social security/insurance number, citizen/personal identiﬁcation/service code/number, and resident registration number.

Note: These are selected deﬁnitions provided to assist you with the completion of this form. Further details

can be found within the OECD Common Reporting Standard for Automatic Exchange of Financial

Account Information (the CRS’), the associated Commentary to the CRS, and domestic guidance.

This can be found at the following link:

http://www.oecd.org/tax/transparency/automaticexchangeofinformation.htm

If you have any questions then please contact your tax adviser or domestic tax authority.

Fill Online, Printable, Fillable, Blank CRS–I - Individual Tax Residency Self-Certification Form Form

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Fillable CRS–I - Individual Tax Residency Self-Certification Form

Fill Online, Printable, Fillable, Blank CRS–I - Individual Tax Residency Self-Certification Form Form

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