Investment Fund Withholding Tax Form
1. Investor Information
Full Name / Entity Name
Tax Identification Number
Address
Country of Residence
Email
Phone
2. Fund Information
Fund Name
Fund ID / ISIN
Account Number
3. Declaration
I hereby declare that the above information is accurate and complete to the best of my knowledge, and I request the appropriate application of withholding tax in accordance with the applicable laws and treaties.
Signature / Name
Date