Fatca (Us Foreign Account Tax Compliance Act) Declaration printable pdf download

Fatca (Us Foreign Account Tax Compliance Act) Declaration

FATCA (US Foreign Account Tax Compliance Act)

Declaration

(this form must be completed and signed)

The Australian Government has entered into an Inter-Governmental Agreement with the Government of the United States of America for

reciprocal exchange of taxpayer information. As part of this agreement Centuria is required obtain ‘self-certification’ from all investors

under FATCA.

This form is used to self-certify your US connection for tax purposes. Further information on FATCA can be found in Centuria’s FATCA

Guide on our website:

Section 1: Individuals

Are one or more individuals a US citizen or a resident of the US for tax purposes?

Yes

Investor 1 US Tax Payer Identification Number (TIN)

Investor 2 US Tax Payer Identification Number (TIN)

Go to Signatories

Section 2: Trusts

Please select one of the categories below that Identifies the trust that you are investing through.

2.1 US Trust

- Provide the Entity’s TIN

- Is this entity an Exempt Payee for US tax purposes

Yes

2.2 Financial Institution or a Trust with a Trustee that is a Financial Institution

(A trust may be a Financial Institution if it is an investment entity that trades in financial assets or invests, administers, manages

funds, money or certain financial assets on behalf of other persons; or if it has a trustees that is a Financial Institution in its own right.)

(also complete Section 5)

2.3 Deceased Estate (excluding US deceased estates)

2.4 Family Trust / Unit Trust / Other Trusts

2.4.1 Does the Trust derive more than 50% of its gross income from investment activities (for example rent, capital gains, interest

& dividends)

Yes (go to Section 2.4.2)

No (go to Signatories)

2.4.2 Are there any individuals that are Beneficial Owners, beneficiaries, trustees, settlors that are US Persons for tax purposes?

Yes (go to Section 4)

No (go to Signatories)

Product Disclosure Statement

Fatca (Us Foreign Account Tax Compliance Act) Declaration