FATCA-CRS Annexure for Individual Accounts (including Sole Proprietor)

Details under FATCA and CRS (see instructions)

(Please consult your professional tax advisor for further guidance on your tax residency, if required)

1. Name of the accountholder ______________

2. Customer ID ______________

3. Father’s name_________________(mandatory if PAN not provided)

4. Spouse’s name_____________(optional)

5. Gender: _____________ (Male, Female, Others)

6. PAN__________

7. Aadhaar number _____________(optional)

8. Identification Type and Identification Number (Documents1 submitted as proof of identity of the individual): Name
of the document submitted ___________________
Identification number _________________

9. Occupation Type_______________(Service, Business, Others-please specify)

10. Date of birth __________________ (in DD/MM/YYYY format)

11. Nationality_______________

12. City of birth ____________

13. Country of birth ______________________

1
Permissible documents are:

 Passport
 Election ID Card
 PAN Card
 ID Card
 Driving License
 UIDAI Card
 NREGA Job Card
 Others

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 FATCA-CRS Annexure for Individual Accounts (including Sole Proprietor)
14. Residence address for tax purposes (include City, State, Country & Pin code)
______________________________________

15. Address Type: _________ (a)Residential or Business (b) Residential (c)Business (d) Registered Office
16. Tax residence declaration – tick any one, as applicable to you:

I am a tax resident of India and not resident of any other country

Or
I am a tax resident of the country/ies mentioned in the table below

Country # Tax Identification Number% Identification Type (TIN or Other ,

%

please specify)

#
To also include USA, where the individual is a citizen/ green card holder of USA
% $
In case Tax Identification Number is not available, kindly provide functional equivalent

Certification
I have understood the information requirements of this Form (read along with the FATCA-CRS Instructions) and
hereby confirm that the information provided by me on this Form is true, correct, and complete. I also confirm that
I have read and understood the FATCA-CRS Terms and Conditions and hereby accept the same.

Name:
Signature:

Date: __/ ___/ ____ Place: _________________________

FATCA-CRS Terms and Conditions

Details under FATCA-CRS/Foreign Tax Laws: Towards compliance with tax information sharing laws, such as FATCA
and CRS, we would be required to seek additional personal, tax and beneficial owner information and certain certifications
and documentation from our account holders. Such information may be sought either at the time of account opening or any
time subsequently. In certain circumstances (including if we do not receive a valid self-certification from you) we may be
obliged to share information on your account with relevant tax authorities. If you have any questions about your tax residency,
please contact your tax advisor. Should there be any change in any information provided by you, please ensure you advise
us promptly, i.e., within 30 days. Towards compliance with such laws, we may also be required to provide information to
any institutions such as withholding agents for the purpose of ensuring appropriate withholding from the account or any
proceeds in relation thereto. As may be required by domestic or overseas regulators/ tax authorities, we may also be
constrained to withhold and pay out any sums from your account or close or suspend your account(s).

FATCA-CRS Instructions

If you are a US citizen or resident or greencard holder, please include United States in the foreign country information
field along with your US Tax Identification Number. Foreign Account Tax Compliance provisions (commonly known as
FATCA) are contained in the US Hire Act 2010.
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 FATCA-CRS Annexure for Individual Accounts (including Sole Proprietor)
$
It is mandatory to supply a TIN or functional equivalent if the country in which you are tax resident issues such identifiers. If
no TIN is yet available or has not yet been issued, please provide an explanation and attach this to the form.
Please note that you may receive more than one request for information if you have multiple relationships with ABC or its
group entities. Therefore, it is important that you respond to our request, even if you believe you have already supplied any
previously requested information.

In case customer has the following Indicia pertaining to a foreign country and yet declares self to be non-tax resident in the
respective country, customer to provide relevant Curing Documents as mentioned below:

FATCA/ CRS Indicia observed Documentation required for Cure of FATCA/ CRS indicia
(ticked)
1. Self-certification that the account holder is neither a citizen of United States of
U.S. place of birth
America nor a resident for tax purposes;
2. Non-US passport or any non-US government issued document evidencing
nationality or citizenship (refer list below); AND
3. Any one of the following documents:
a. Certified Copy of “Certificate of Loss of Nationality or
b. Reasonable explanation of why the customer does not have such a certificate
despite renouncing US citizenship; or Reason the customer did not obtain U.S.
citizenship at birth
1. Self-certification that the account holder is neither a citizen of United States of
Residence/mailing address in a
America nor a tax resident of any country other than India; and
country other than India
2. Documentary evidence (refer list below)
If no Indian telephone number is provided
Telephone number in a country other
1. Self-certification that the account holder is neither a citizen of United States of
than India
America nor a tax resident of any country other than India; and
2. Documentary evidence (refer list below)

If Indian telephone number is provided along with a foreign country telephone

number
1. Self-certification that the account holder is neither a citizen of United States of
America nor a tax resident for tax purposes of any country other than India; OR
2. Documentary evidence (refer list below)
1. Self-certification that the account holder is neither a citizen of United States of
Standing instructions to transfer
America nor a tax resident of any country other than India; and
funds to an account maintained in a
2. Documentary evidence (refer list below)
country other than India (other than
depository accounts)

List of acceptable documentary evidence needed to establish the residence(s) for tax purposes:
1. Certificate of residence issued by an authorized government body*
2. Valid identification issued by an authorized government body* (e.g. Passport, National Identity card, etc.)
* Government or agency thereof or a municipality of the country or territory in which the payee claims to be a resident.

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