Fatca Declaration Form (Page 2 of 3) in pdf

Fatca Declaration Form Page 2

U.S. Indicia Status (Corporate)

Yes

Document Required If Yes

1. Is the company / entity incorporated in the U.S.?

2. Does the company have a U.S. beneficiary?

3. Is any of the company’s director / promoter /authorized signatory /

POA holder based in out of the U.S. or holds U.S. residence /

citizenship?

4. Does the company have one or more U.S. beneficial owners /

W-9 Form

shareholders with more than 10% ownership on vote or value of a

stock?

5. Does the company have partners (of U.S.) owning more than 10%

profit or capital interest in a partnership?

6. Any U.S. “owner” of a grantor trust or, to the extent provided in

regulations, a more than 10% beneficial interest in a trust?

7. Does the company pay tax in the U.S.?

W-8 BEN-E Form for non-U.S. entity

8. Does the company hold a mailing address or communication

address in the U.S.?

W-9 Form for U.S. entity

9. Does the company have a U.S telephone number?

W-8 BEN-E Form

Section B

Client Details

1. Name or Registered Business Name (as per official document).

2. NRIC or Passport No. or Business Registration No.

3. Client Code.

3. Mailing Address.

5. Email Address

6. U.S. TIN* (if any).

4. Telephone Number

* U.S. TIN refers to United States Taxpayer identification number. It is a unique number used by the tax authorities to identify a person or

business in the tax system for the purpose of tax administration.

Fatca Declaration Form Page 2