Form 8957 - Foreign Account Tax Compliance Act (Fatca) Registration Page 4
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4Form 8957 (Rev. 6-2017)
4
Page
Part 2
Expanded Affiliated Group (continued)
13a
Is the Financial Institution the Common Parent Entity of the Expanded Affiliated Group?
Yes (If “Yes,” go to Signature line)
No (If “No,” complete line 13b)
b
Enter the Legal Name of the Expanded Affiliated Group’s Common Parent Entity. Also enter the FATCA ID (if known).
Legal Name of the Common Parent Entity
▶
FATCA ID
▶
SIGNATURE
By checking this box, I,
, certify that, to the best of my knowledge, the information submitted above is accurate and
complete and I am authorized to agree that the Financial Institution (including its branches, if any) will comply with its FATCA obligations in
accordance with the terms and conditions reflected in regulations, intergovernmental agreements, and other administrative guidance to the
extent applicable to the Financial Institution based on its status in each jurisdiction in which it operates.
I declare that I have examined this form including any accompanying statements, and to the best of my knowledge and belief, it is true, correct, and complete.
Sign
Here
Signature
Date
8957
Form
(Rev. 6-2017)
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