FATCA/CRS Self-Certification Form (Corporate)
1. Entity Information
Full Legal Name of Entity
Country of Incorporation/Organisation
Registration Number
Registered Address
Mailing Address (if different from registered address)
2. FATCA/CRS Classification
1. Please select one of the following entity types:
Financial Institution
Active Non-Financial Entity (NFE)
Passive Non-Financial Entity (NFE)
2. If Financial Institution, please select:
Reporting
Non-Reporting
3. If Financial Institution, provide GIIN (if applicable)
3. Controlling Persons (for Passive NFE only)
Name
Country(ies) of Tax Residence
TIN(s)
4. Tax Residency Details
Country(ies) of Tax Residence
TIN(s) or functional equivalent(s)
5. Declaration & Signature
Authorised Signatory Name
Position/Title
Date (dd/mm/yyyy)
Signature