How to complete a Tax Residency Self-Certification Form. Tax Residency Self-Certification Form. For UK Family Trusts only
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1 How to complete a Tax Residency Self-Certification Form How to complete a Tax Residency Self-Certification Form For Family Trusts only
2 When should this form be used? This form is only for use by trustees of Family Trusts. A Family Trust is a Trust where: The trustees are all individuals, all of whom are resident; and the settlors (where living) are all individuals, all of whom are resident; and the protectors (where present) are all individuals, all of whom are resident; and the named beneficiaries are all individuals, all of whom are resident. Non- residents If any of the above individuals are tax resident somewhere other than the, or are tax resident in another country as well as the, the Trust will not be a Family Trust and the trustees should complete the Tax Residency Self-Certification Form for Entities (reference: 6503) instead of this form. What is meant by the term Controlling Persons? The inter-governmental agreements use the term Controlling Persons to describe the persons who exercise control over an Entity. In the case of a company, these persons will be the directors and shareholders. For a Trust (such as a Family Trust) these persons are the trustees, the settlors, the protectors (if any), the beneficiaries or class of beneficiaries, and any other person exercising ultimate effective control over the Trust. The term Controlling Persons will be interpreted in a manner consistent with the Financial Action Task Force (FATF) Recommendations, which can be found at: Holders of US citizenship If any of the above individuals: are citizens of the United States of America, hold US citizenship in addition to British or other citizenships or, hold a US passport or Green Card please contact us to discuss your options before completing this form. Non-natural persons If any of the trustees, settlors, protectors, or beneficiaries are not individuals (e.g. if they are companies), the trustees should, instead complete the Tax Residency Self- Certification Form for Entities (reference: 6503). of the United States of America. Currently the Isle of Man has entered into two such agreements with the US Government and with the Government, however similar agreements are expected to be made between the Isle of Man and other countries/jurisdictions in the future. Legislation passed on the Isle of Man relating to these intergovernmental agreements, has made it a legal obligation for financial services companies such as Canada Life International Limited and CLI Institutional Limited (together the Company ) to collect certain information about each customer s tax circumstances, including their worldwide tax residency status and corresponding tax reference numbers. This information will be stored on our records, but will only be disclosed to the relevant tax authorities if and when we are required to under Isle of Man law. Please note that the inter-governmental agreements will not change the requirement for Isle of Man life assurance companies to report chargeable events to HM Revenue & Customs, where applicable. What is meant by the term Entity? All inter-governmental agreements use the term Entity to describe incorporated entities (such as companies, limited liability partnerships and foundations), as well as unincorporated entities and legal arrangements (such as ordinary/general/simple partnerships or Trusts). A Family Trust will therefore be treated as an Entity under the inter-governmental agreements. When completing this form the trustees should be aware that the Trust itself will need to be treated as if it were a separate body whilst answering any questions under Sections 1, 2, 3, 4 and 6. Tax residency Tax residency rules for Entities vary from country to country, and can be quite complicated. For instance, a company will often be tax resident in the country where it is incorporated and may also be tax resident in any other countries in which it conducts business, while the tax residency of a Trust may depend on where its trustees are resident or the law under which it was created. If there is doubt about where an Entity is tax resident, we recommend that you speak to your tax or legal adviser. If you have any questions on how to complete Sections 1 to 5 we recommend that you speak to your tax or legal adviser, as the Company is not authorised to give such advice. Tax Residency and Tax Information Please read the following carefully before completing sections 1 to 6. Sections 1 to 6 must be completed in all cases. Background The Isle of Man Government is and will be party to a number of inter-governmental agreements to share tax information, where applicable, with the tax authorities in other countries/ jurisdictions. These agreements have been prompted by legislation commonly known as the Foreign Account Tax Compliance Act or FATCA, passed by the Government 2 How to complete a tax residency self-certification form for family trusts only
3 Section 1 Name of the Trust Confirmation Policy number(s) (if applicable) Name of the Family Trust and relevant Policy Number(s) TRUSTEES OF THE M SMITH SETTLEMENT This Trust is a Family Trust (please tick to confirm that the Trust meets the criteria of a Family Trust) XXX / XYZ / Section 2 Tax reference number Tax residency status of the Family Trust (an Entity ) As a Family Trust, the Trust named in Section 1 will be tax resident in the, however, if the Trust is also tax resident in other countries/jurisdictions, please list them all in the table below, together with any corresponding tax reference numbers. The inter-governmental agreement between the and the Isle of Man states that a tax resident Entity (such as a Family Trust) should supply its tax reference number (where one has been issued). Entities (such as Family Trusts) that are also tax resident in other countries/jurisdictions should supply the tax reference numbers appropriate to those countries/jurisdictions as well. Tax residency of the trust Countries/Jurisdictions of tax residency United Kingdom () Tax reference numbers Should the tax residency of the Trust change at any time in the future, you must notify the Company immediately. No requirement to complete Section 3 The Inter-Governmental Agreement between the US and the Isle of Man As a Family Trust, under the inter-governmental agreement between the US and the Isle of Man the Trust named in Section 1 has the classification of a: Passive Non-Financial Foreign Entity (we have indicated the Trust s classification for you) Consequently annual reporting will not be made to the US tax authorities. Please note, however, that the Trust s classification and reportable status may be subject to change should the tax residency of the trustees, settlor, protector, beneficiaries or the Trust itself change in the future. No requirement to complete Section 4 The Inter-Governmental Agreement between the and the Isle of Man As a Family Trust, under the inter-governmental agreement between the and the Isle of Man the Trust named in Section 1 has the classification of a: Specified Person (we have indicated the Trust s classification for you) Consequently annual reporting will be made to the tax authorities. Please note, however, that the Trust s classification and reportable status may be subject to change should the tax residency of the trustees, settlor, protector, beneficiaries or the Trust itself change in the future. If the trust is set up in a different jurisdiction to that of the then a tax reference number may have been issued. If it is a based trust then insert in this section. The majority of Family Trusts in the will not have a tax reference number however if you have been provided with one please can you detail it here otherwise insert. If the trust was set up outside of the then a Tax Reference number may have been issued again if you have this then please complete this section. Tax residency self-certification form for family trusts only 3 How to complete a tax residency self-certification form for family trusts only 3
4 Section 5 Only Trustees details are required in this section Tax reference number Please note Title (Mr, Mrs, Miss, Ms, other) Tax Residency Status of the Trustees, Settlors, Protectors and Beneficiaries (the Controlling Persons ) As the Trust named in Section 1 has a classification of Passive NFFE under the inter-governmental agreement between the US and the Isle of Man, we are also required to collect tax information about each Controlling Person (such as a Trustee, Settlor etc.). The majority of such information is also required to meet our obligations to undertake customer due diligence. Please complete each Controlling Person s details and the countries/jurisdictions in which they are tax resident, together with the corresponding tax reference numbers in the relevant boxes below. The inter-governmental agreement between the and the Isle of Man states that a tax resident Controlling Person (such as a Trustee, Settlor etc.) individual should supply their National Insurance Number as the tax reference number. Controlling Persons who are also tax resident in other countries/jurisdictions should supply their tax reference numbers for those countries/jurisdictions as well. The trustees of the Trust named in Section 1 will be making this declaration on behalf of the Controlling Persons as well as for the Trust itself. MR Trustee 1 MRS Trustee 2 Surname SMITH SMITH Forename(s) in full Sex Permanent residential address in full JOHN JANET Male 4 Female Male Female 4 14 WINDSOR ROAD 14 WINDSOR ROAD WINDSOR WINDSOR T D 7 4 Q S T D 7 4 Q S Telephone numbers (including STD codes. At least one landline telephone number required) Daytime Evening Mobile Code Area Code Local Number Code Area Code Local Number Daytime Evening Mobile address Correspondence address in full (if different from your permanent residential address) JSMITH@ .NET JANSMITH@ .NET Date of birth of birth 14 / 10 / / 01 / 56 Please list all Nationalities / Citizenships held BRITISH BRITISH Please list all countries of tax residency Please list the corresponding NI/tax reference numbers AB123456C AB456789D 4 Tax residency self-certification form for family trusts only 4 How to complete a tax residency self-certification form for family trusts only
5 Section 5 Tax Residency Status of the Trustees, Settlors, Protectors and Beneficiaries (the Controlling Persons ) continued Trustee 3 Trustee 4 Title (Mr, Mrs, Miss, Ms, other) Surname Forename(s) in full Sex Male Female Male Female Permanent residential address in full Telephone numbers (including STD codes. At least one landline telephone number required) Daytime Evening Code Area Code Local Number Daytime Evening Code Area Code Local Number Mobile Mobile address Correspondence address in full (if different from your permanent residential address) Date of birth / / / / of birth Please list all Nationalities / Citizenships held Please list all countries of tax residency Please list the corresponding NI/tax reference numbers Tax residency self-certification form for family trusts only 5 How to complete a tax residency self-certification form for family trusts only 5
6 Section 5 Only Settlor s details are required in this section Title (Mr, Mrs, Miss, Ms, other) Surname Forename(s) in full Tax Residency Status of the Trustees, Settlors, Protectors and Beneficiaries (the Controlling Persons ) continued MR SMITH MICHAEL Settlor 1 Settlor 2 If the Settlor is no-longer living, please provide their date of death Permanent residential address in full Sex Male 4 Female 17 / 06 / BARCLAY LANE WINDSOR T D Q S Male Female / / Date of birth of birth Please list all Nationalities / Citizenships held 01 / 02 / 33 / / BRITISH Please list all countries of tax residency Please list the corresponding NI/tax reference numbers AA123456B 6 Tax residency self-certification form for family trusts only 6 How to complete a tax residency self-certification form for family trusts only
7 Section 5 Only Protectors details are required in this section Title (Mr, Mrs, Miss, Ms, other) Tax Residency Status of the Trustees, Settlors, Protectors and Beneficiaries (the Controlling Persons ) continued Protector 1 (where one exists) Protector 2 (where one exists) Surname Forename(s) in full Permanent residential address in full Sex Male Female Male Female Date of birth / / / / of birth Please list all Nationalities / Citizenships held Please list all countries of tax residency Please list the corresponding NI/tax reference numbers Tax residency self-certification form for family trusts only 7 How to complete a tax residency self-certification form for family trusts only 7
8 Section 5 Only Beneficiary details are required in this section where they are named within the trust Title (Mr, Mrs, Miss, Ms, other) Surname Forename(s) in full Permanent residential address in full Tax Residency Status of the Trustees, Settlors, Protectors and Beneficiaries (the Controlling Persons ) continued Sex Male Female MISS SMITH ALISON Beneficiary 1 (where named) 14 WINDSOR ROAD WINDSOR 4 MR Male 4Female T D 7 4 Q S T D 7 4 Q S SMITH JACK Beneficiary 2 (where named) 14 WINDSOR ROAD WINDSOR Date of birth of birth 10 / 04 / / 09 / 86 Please list all Nationalities / Citizenships held BRITISH BRITISH Please list all countries of tax residency Please list the corresponding NI/tax reference numbers AC987654C AC654321C 8 Tax residency self-certification form for family trusts only 8 How to complete a tax residency self-certification form for family trusts only
9 Section 5 Tax Residency Status of the Trustees, Settlors, Protectors and Beneficiaries (the Controlling Persons ) continued Beneficiary 3 (where named) Beneficiary 4 (where named) Title (Mr, Mrs, Miss, Ms, other) Surname Forename(s) in full Permanent residential address in full Sex Male Female Male Female Date of birth / / / / of birth Please list all Nationalities / Citizenships held Please list all countries of tax residency Please list the corresponding NI/tax reference numbers Tax residency self-certification form for family trusts only 9 How to complete a tax residency self-certification form for family trusts only 9
10 Data Protection Notice Any personal information you may provide to Canada Life International Limited or CLI Institutional Limited (together, the Company ) as data controller will be treated in accordance with the Isle of Man Data Protection Act 200 By signing this form you consent to the Company using and sharing your personal information as set out in this notice including, without limitation, the processing of personal sensitive data. If submitting personal information about another person, by signing this form you confirm that you have their consent to provide such information to the Company and for their information to be used as set out in this notice. Using personal information The Company uses personal information to undertake any activity relating to its policies, products and services and, where relevant, to process applications, set-up and administer policies, products and services and handle any claims. Sharing personal information The Company may share personal information: With other Canada Life companies including those outside the European Economic Area; with its relevant reassurers; with approved service providers including providers of medical services and opinions; with the Isle of Man Assessor of Income Tax or his or her delegate; with the Isle of Man Insurance and Pensions Authority; with the Financial Conduct Authority; with the Prudential Regulation Authority; with any other regulators with competent jurisdiction; with the Isle of Man Financial Services Ombudsman Scheme; with the Financial Ombudsman Service; with any other applicable financial services ombudsman schemes or supervisors; with other insurers; with relevant industry bodies such as the Association of International Life Offices, if appropriate; with any relevant tax authority if and when we are required to under Isle of Man law; with other companies, organisations and associations and/or credit reference agencies in order to prevent, detect or investigate financial crime or fraud; with law enforcement agencies; and in any circumstances if permitted or required to do so by law or if the Company has consent to do so. Where the information is being released to any of the above, the Company may use electronic communications. Relevant industry bodies may share information about you collected by other insurances companies with the Company. The Company will not use your information to advise you of other products and services offered by third parties or companies within the Canada Life marketing group. Accessing personal information A person whose personal information is held by the Company has various rights including the right to: Have any incorrect personal information corrected; and/or access the personal information the Company holds for which a fee may be charged. To do so and/or if you need more information, please contact the Company. Requests and queries should be addressed to the relevant company, as follows: The Data Protection Officer Canada Life International Limited Canada Life House Isle of Man Business Park Douglas Isle of Man IM2 2QJ The Data Protection Officer CLI Institutional Limited Canada Life House Isle of Man Business Park Douglas Isle of Man IM2 2QJ 10 Tax residency self-certification form for family trusts only 10 How to complete a tax residency self-certification form for family trusts only
11 Section 6 Please note that it is not necessary for all trustees to sign and we would be happy to accept the completed form signed by one of the trustees on behalf of all controlling persons. Please note Declaration by the trustees We may be required to request additional information or documentary evidence to support your declaration made in Sections 1 to 6 in order to meet the obligations in relation to the intergovernmental agreements. I/We, the undersigned, declare and agree the following: To my/our best knowledge and belief the statements made in this form are complete and true and contain all material facts. A material fact is one that determines the classification under the relevant inter-governmental agreements. Failure to give complete and true answers and disclose all material facts could result in the contract(s) being void. If there is any doubt whether a certain fact is material it should be disclosed. Where I/we have declared the tax residency and other details of the Controlling Persons of the Trust named in Section 1 on their behalf, the declarations have been made to the best of my/our knowledge and belief and are complete and true. The statements above are all true and complete and I/we will inform the Company of any change to any material fact during the time the contract is in force. Where there are two or more signatories, the foregoing declaration is made by us jointly and severally. Signature Print name Date Trustee 1 J.Smith JOHN SMITH 06 / 05 / Trustee 2 / / 2 Signature Trustee 3 Trustee 4 Print name Date / / 2 / / 2 Tax residency self-certification form for family trusts only 11 How to complete a tax residency self-certification form for family trusts only 11
12 Canada Life International Limited, registered in the Isle of Man no Registered office: Canada Life House, Isle of Man Business Park, Douglas, Isle of Man IM2 2QJ. Telephone: +44 (0) Fax: +44 (0) Member of the Association of International Life Offices. CLI Institutional Limited, registered in the Isle of Man no C. Registered office: Canada Life House, Isle of Man Business Park, Douglas, Isle of Man IM2 2QJ. Telephone: +44 (0) Fax: +44 (0) Member of the Association of International Life Offices. Canada Life International Limited and CLI Institutional Limited are Isle of Man registered companies authorised and regulated by the Isle of Man Financial Services Authority. ID R
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