*FATCAI*

FATCAI

SELF CERTIFICATION ON TAX RESIDENCY STATUS

Please read the instructions on Page 4 before completing this form. Mandatory to complete all sections.

1 Identification of Individual Accountholder

Full Name (as per NRIC/Passport)

NRIC/Passport Number Date of Birth (DD/MM/YYYY)

Current Residence Address1

City2 Postal/Zip Code

Country

Singapore Foreign (please specify)

2 Country/Jurisdiction of Residence for Tax Purposes and Related Tax Identification Number or Equivalent
Number ("TIN")
Completion of Section 2(A) for FATCA and Section 2(B) for CRS are mandatory. Please indicate:-
(i) Your US Person status and SSN if you are a US Person.
(i) All countries and/or jurisdictions (including Singapore and US) where you are a tax resident; and
(ii) Your TIN for each country/jurisdiction indicated.
Note: If you are a tax resident in more than four countries/jurisdictions, please use a separate sheet. If a TIN is unavailable, please select either one of the reason.

2(A) FATCA
US Person Social Security No. (SSN) or TIN (9 digits)

Non US Person (A copy of Non-US passport or Non-US government issued identification is attached)

I was a US Person and I am no longer a "US Person" (A copy of Certificate of Loss of Nationality of the US is attached)

2(B) CRS
Singapore TIN/FIN (For Singapore the TIN is your NRIC or FIN)
Other Countries:

(i) Country/Jurisdiction of Tax Residence TIN

If TIN is not available, select a reason

Country/Jurisdiction does not issue TIN TIN not required to be disclosed3

(ii) Country/Jurisdiction of Tax Residence TIN

If TIN is not available, select a reason

Country/Jurisdiction does not issue TIN TIN not required to be disclosed3

1
In the event that your current residential address is different from the Bank's record or you have changed your place of residential address, please update your
address via the UOB TMRW App with Singpass or in-person at any UOB Branch.
CRS-2 (R4.24)

2
City is only applicable for Foreign addresses
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3
To be selected only if the law of the country of tax residence stated above does not require the TIN to be collected

United Overseas Bank Limited Co. Reg. No. 193500026Z Page 1 of 4

 Self Certification on Tax Residency Status
(iii) Country/Jurisdiction of Tax Residence TIN

If TIN is not available, select a reason

Country/Jurisdiction does not issue TIN TIN not required to be disclosed3

(iv) Country/Jurisdiction of Tax Residence TIN

If TIN is not available, select a reason

Country/Jurisdiction does not issue TIN TIN not required to be disclosed3

2(C) Clarification on Tax Residence Information (where relevant)

If the current Residential Address (including your Attorney’s residential address), Mailing Address(es) and Contact Number(s)^ previously
provided by you do not correspond with your declared country/jurisdiction of tax residence, please select the appropriate reasonable explanation
and provide a copy of documentary evidence, where applicable.

Select one appropriate reasonable explanation

I am a student at an educational institution in the relevant jurisdiction and holds an appropriate pass/visa (if applicable).
I am a teacher, trainee, or intern at an educational institution in the relevant jurisdiction and holds an appropriate pass/visa (if applicable).
I am a participant in an educational or cultural exchange visitor program and holds an appropriate pass/visa (if applicable).
I am a foreign individual assigned to a diplomatic post or a position in a consulate or embassy in the relevant jurisdiction.
I am a frontier worker or employee working on a truck or train traveling between jurisdictions.
I am a foreign individual in the relevant jurisdiction and does not meet the minimum number of days to be considered as physically present,
and hence not a tax resident in the relevant jurisdiction.
My mailing address is my office address/trusted acquaintance/relative as I am on social visit pass (if applicable)
The residential address of my appointed Attorney / signatory does not have any impact on my tax residency.

3 Authorisations and Undertakings

Information
Ÿ I understand that the information provided herein is subject to the terms and conditions governing the Accountholder’s relationship with
United Overseas Bank Limited (“UOB”).
Ÿ I confirm that all information in this form is accurate, complete and true. To the best of my knowledge, the information provided in this form
does not conflict with any other information provided to UOB.
Documentation
• I agree to provide UOB with such documents as UOB may require from time to time in its sole discretion for the purpose of UOB satisfying
itself that the information herein is valid.
• I have provided documentation to establish a tax residence in a particular jurisdiction(s) as declared in this form (“the Declared
Jurisdiction(s)”).
• I further confirm that the aforesaid documentation is valid and issued by an authorised government authority located in the Declared
Jurisdiction(s).
• I confirm that I am the individual named in the aforementioned documentation.
Changes in Circumstances
• I undertake to notify UOB and to provide UOB with a suitably updated Self-Certification form within 30 days of any change in circumstances
which affects the tax residency status of the Accountholder named in Section 1 above or causes the information contained herein to
become incorrect.
• Without prejudice to any other rights or remedies UOB may otherwise have, I shall indemnify, keep indemnified and hold harmless UOB
against any and all liabilities, actions, claims, losses, damages, costs and expenses (including but not limited to legal costs on a full
indemnity basis) suffered or incurred by UOB as a result of, or in connection the information herein being inaccurate, outdated or untrue.
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.
Note: If you are not the Accountholder, please indicate the capacity in which you are signing the form. An authorised representative or officer must state the
capacity in which he/she is signing on behalf of the Accountholder. If this form is completed by an agent acting under a duly authorised Power of Attorney, the
form must be accompanied by the Power of Attorney in proper form specifically authorising the agent to represent the Accountholder in making, executing and
presenting the form.

Signature Name / NRIC / Passport Number

Capacity (if applicable) Parent / Guardian / Trustee / Authorised Rep

Date (DD/MM/YYYY)
CRS-2 (R4.24)

^ Where there is no Singapore Contact Number

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To be selected only if the law of the country of tax residence stated above does not require the TIN to be collected
Page 2 of 4
 For Bank Use Only
Attended By Indicia that does not Country that does not
correspond with declaration correspond with declaration

Signature and Name Date

Residential Address

Signature Verified By (For Thumbprint-Witnessed by) Mailing Address(es)

(Linked to Reportable Product Types)

Signature and Name Date Contact Number Type & Country Home / Mobile / Office* Country:
(Only when there is NO Singapore
Number)

Note: Non-Reportable Product Types - Loans / CC / CPFIS / CDA / PRU

For COC Use Only

Processed By Approved By

Signature and Name Date Signature and Name Date

* Please select/delete where applicable

CRS-2 (R4.24)

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Page 3 of 4
 Common Reporting Standard (“CRS”) & Foreign Account Tax Compliance Act
("FATCA") Self-Certification Form (Individual Accountholder)
Instructions

1. Please complete this form if you are an individual Accountholder. For joint or multiple Accountholders, please use a separate form for each
individual Accountholder. If the Accountholder is a minor, this form should be completed by the parent or legal guardian of the minor. If the
Accountholder is mentally incapacitated, the relevant Power of Attorney holder should complete this form.
2. Please complete all sections in a legible manner. The form must be signed and dated.
3. The following will render this form invalid:
a. Alterations to the pre-printed content;
b. Use of correction fluid or tape.
c. Failure to state address in full, namely failing to specify the relevant Current Residence Address, City, Country and Postcode for your
address.
4. Please ensure that both Sections 2(A) and (B) are completed for FATCA and CRS respectively. It is mandatory for these sections to be
completed.

Explanatory Notes

1. “TIN” means Taxpayer Identification Number. It refers to a unique identifier assigned to the Individual by a tax administration in the Individual’s
jurisdiction of tax residence.
2. “CRS” means the Common Reporting Standard.
United Overseas Bank Limited (“UOB”) is required under the Income Tax (International Tax Compliance Agreements) (Common Reporting
Standard) Regulations 2016 (“the Regulations”) to collect information about each account holder’s tax residency status. UOB is required to
submit this information to the Inland Revenue Authority of Singapore (“IRAS”) to comply with the Regulations.
3. “FATCA” means the Foreign Account Tax Compliance Act.
UOB is obliged under the Income Tax (International Tax Compliance Agreements) (United States of America) Regulations 2015, Income Tax
(International Tax Compliance Agreements) (United States of America) Regulations 2020 to collect each account holder’s US/ Non-US Person
status for FATCA purposes. UOB is required to submit this information to the Inland Revenue Authority of Singapore (“IRAS”) to comply with
the Regulations.
4. UOB may seek additional information from you after the submission of this form to ensure compliance with the aforementioned Regulations
and any other relevant laws enacted to implement CRS and FATCA.
5. Whether a person is tax resident in a particular country depends on whether that person meets the definition of a tax resident under the
tax laws of that country. UOB does not provide tax advice. Please consult your tax, legal and/or other professional advisers if you have any
questions on or in relation to CRS and FATCA, the Regulations and the information requested in this Self-Certification Form.
6. “US Person”
(a) A US Citizen or resident individual.
(b) A partnership or corporation organised in the US or under the laws of the US or any state of the US.
(c) A trust if (i) a court within the US would have authority under applicable law to render orders or judgements concerning substantially all
issues regarding administration of trust, and (ii) one or more US Persons have the authority to control all substantial decisions of the trust,
or an estate of a decedent that is a citizen or resident of the US.
This definition shall be interpreted in accordance with the US Internal Revenue Code. Please note that persons who have lost their US
citizenship and who live outside the US may nonetheless in some circumstances be treated as US Persons.
• If you hold multiple citizenships and one of them is US, you are a US Person.
• If you have a US Green Card, you are a US Person.
• If you were born in the US or a US Territory (Puerto Rico, Guam, US Virgin Islands or Northern Mariana Islands), you are a US Person.
• If you meet the substantial presence test, you are a US Person. To meet this test, you must be physically present in the United States at
least:
1. 31 days during the current year; and
2. 183 days during the 3-year period that includes the current year and the 2 years immediately before that, counting:
• All the days you were present in the current year;
• 1/3 of the days you were present in the first year before the current year; and
• 1/6 of the days you were present in the second year before the current year.
CRS-2 (R4.24)

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United Overseas Bank Limited Co. Reg. No. 193500026Z Page 4 of 4