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CRS-I Form

This document is an individual tax residency self-certification form containing the following sections: 1) Account holder information including name, address, place of birth. 2) Tax residency information including country of tax residency, tax identification number, and reason if number is unavailable. 3) Declarations that information can be shared with tax authorities and certification that the account holder has determined their own tax residency status.

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mramzan9820
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28 views2 pages

CRS-I Form

This document is an individual tax residency self-certification form containing the following sections: 1) Account holder information including name, address, place of birth. 2) Tax residency information including country of tax residency, tax identification number, and reason if number is unavailable. 3) Declarations that information can be shared with tax authorities and certification that the account holder has determined their own tax residency status.

Uploaded by

mramzan9820
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Individual Tax Residency Self-Certification Form CRS-I

Please complete Parts 1– 3 in BLOCK CAPITALS. Fields marked with a * are mandatory.
Note: Fill and complete Part 2 only if Tax Residency is other than USA & Pakistan otherwise mark “Not Applicable (N/A)”.

Part 1
A. Name of Account Holder:*
Family Name or

First or Given
Middle Name(s)

B. Current Residence Address:*

C. Mailing Address: (Only complete if different from the address shown in Section B above)

D. Place of birth*
Town or City of Birth* Country of Birth*

Part 2
Please provide in the table below information about Account Holders country of tax residence/tax filer/payer. If the Account Holder is
a tax resident/filer/payer in more than three countries please use a separate sheet.
(Mandatory only if country of tax residence is other than Pakistan & USA otherwise mark “Not Applicable (N/A)”.)
(i)Country where tax is paid (Tax (ii)NTN/TIN or any form of tax (iii)If NTN/TIN or any form of tax identification number is not
Residency) identification number available enter Reason A, B or C

If a TIN is unavailable please provide the appropriate reason A, B or C:

Reason A The country where the Account Holder is liable to pay tax does not issue TINs /NTN to its residents
Reason B The Account Holder is unable to obtain a NTN/TIN or equivalent number.
Reason C No TIN/NTN is required. (Note. Only select this reason if the authorities of the country of tax residence entered below do not
require the NTN/TIN to be disclosed)

Please explain in the following boxes why you are unable to obtain a TIN if you selected Reason B above.
1

3
Individual Tax Residency Self-Certification Form CRS-I
Part 3
Declarations and Signature*
I understand that the information supplied by me is covered by the full provisions of the terms and conditions governing the
Account Holder’s relationship with UBL setting out how UBL may use and share the information supplied by me.

I acknowledge that the information contained in this form and information regarding the Account Holder and any Reportable
Account(s) may be provided to the tax authorities of the country in which this account(s) is/are maintained and exchanged with tax
authorities of another country or countries in which the Account Holder may be tax resident pursuant to intergovernmental
agreements to exchange financial account information.

I certify that I am the Account Holder (or am authorized to sign for the Account Holder) of all the account(s) to which this form
relates.

I declare that I have neither asked for, nor received, any advice from UBL in determining my classification as a Reportable Person or
otherwise.

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