Additional Common Reporting Standard Status (Page 2 of 2) in pdf

Additional Common Reporting Standard Status Page 2

Q3. Non-Reporting Financial Institution /

Internal use

only

Exempt Beneficial Owner

If your organisation is a Non-Reporting Financial Institution or an Exempt Beneficial Owner please tick one of

these boxes:

a) Trustee Documented Trust (if ticked go to Q4)

b) Sponsored Investment Entity (if ticked go to Q4)

c) Sponsored Closely Held Investment Vehicle (if ticked go to Q4)

d) Governmental Entity

e) Central Bank

f) International Organisation

g) Non-profit Organisation

h) Exempt Retirement Fund

i) Entity wholly owned by Exempt Beneficial Owner

j) Qualified Collective Investment Vehicle

k) Qualified Credit Card Issuer

l) Limited life debt investment entity

m) Financial Institution with a Local Client Base

n) Non-Registering local bank

o) Financial Institution with only Low-Value Accounts

p) Investment Advisors and Investment Managers

q) Owner Documented Foreign Financial Institution

r) Non-Reporting Member of Participating Foreign Financial Institution Groups

s) Other (please specify)_________________________________________________________

Q4. Trustee Documented Trust, Sponsored Investment

Entity and Sponsored Investment Vehicle

Name of trustee of Trustee Documented Trust or Sponsoring Entity or Sponsored Closed Held Investment Vehicle:

GIIN of trustee of Trustee Documented Trust or Sponsoring Entity or Sponsored Closed Held Investment Vehicle:

December 15

Page 2 of 2

Additional Common Reporting Standard Status Page 2