Asset Management Corporate Investor Client Information Update Request Form

Transcription

1 Asset Management Corporate Investor Client Information Update Request Form IMPORTANT: Please complete in CAPITAL LETTERS and BLACK INK only, and tick where applicable. Any alteration made must be countersigned. DETAILS OF CORPORATION Account No. Name of Corporation (as per Certificate of Incorporation) Certificate of Incorporation No. Date of Incorporation Income Tax No. D D / M M / Y Y Y Y Status Incorporated in Malaysia Other, please specify Type of Entity Private Limited (Sdn Bhd) Public Limited (Bhd) Partnership Society / Co-operative (Koperasi) State / Federal Government Trustee Nature of Business A If A18-None of the above, please specify For Nature of Business code, please refer to the Appendix page. Tell us about the source of funds for the investment Bank Borrowings Proceeds from disposal of asset Working Capital Dividends Others, please specify Registered Address Town / City Postcode State Country Correspondence Address (if different from the above) Town / City Postcode State Country Contact Details Office No. Contact Person Fax No. Designation Department Direct Line Mobile By completing the column above, you will receive statement via only. If you wish to receive statement in hard copies instead of , please tick here V2 2016

2 1. (a) Is your company listed and quoted on Bursa Securities Bhd? (b) Is your company a subsidiary (at least more than 50% owned) of a company listed and quoted on Bursa Securities Bhd/ except under Practice Note 17 of Bursa's Main Market Listing Requirements or Guidance Note 3 of Bursa's ACE Markets Listing Requirements? (d) Banks, insurance companies & takaful operators licensed under the Islamic Financial Services Act 2013, the FInancial Services Act 2013, the Labuan Financial Services and Securities Act 2010 or the Labuan Islamic FInancial Services and Securities Act 2010? (k) Statutory body established under an Act of Parliament or an order through government gazette. 6. Does your company carry on business outside Malaysia? 7. Does your company own net asset of more than RM15 million (or equivalent in foreign currency)? 5

3 FOREIGN ACCOUNT TAX COMPLIANCE ACT ("FATCA") Affin Hwang Asset Management Berhad ( Company ) and its related companies and affiliates are subject to and required to, or have agreed to comply with FATCA or any other arrangements with foreign governments or regulators which may come into force from time to time ( Reporting Requirements ). Please answer the following questions: TAX RESIDENCY I hereby certify that the corporation identified above is a resident of for tax purpose; and (a) The corporation s Tax Identification Number ( TIN ) or equivalent in its country of residence for tax purposes is ; or (b) The corporation s country of residence for tax purposes does not issue TINs or an equivalent to its residents or the corporation is otherwise unable to procure a TIN or an equivalent from its country of residence (please tick box if relevant) If the entity or organisation is tax resident in more than one jurisdiction please complete the following section as appropriate. Country: TIN: or TIN Unavailable Country: TIN: or TIN Unavailable If the corporation is a tax resident in the United States or holds dual residency, please provide a completed, signed and dated IRS Form W For Financial Institutions only: Please complete (a) or (b) as appropriate. (a) Please provide your Global Intermediary Identification Number (GIIN): Select whichever applicable to you: Participating FFI Registered Deemed Compliant FFI (b) If unable to provide GIIN, please tick the reason why your organisation does not have the GIIN: i. Is it an Exempt Beneficial Owner? ii. Is it a Sponsored Entity? Please provide your sponsor s name and GIIN: Sponsor s name: Sponsor s GIIN: iii. Is it a Certified Deemed Compliant Financial Institution (DCFFI)? iv. Is it a Owner Documented Foreign Financial Institution (ODFFI)? v. Is it a Non-Participating Foreign Financial Institution (NPFFI)? vi. Others, please state: For description of RDCFFI, DCFFI, ODFFI, NPFFI and EBO, please refer to Definition below. 2. For non-financial Institutions only Please confirm if your company is: Public listed entity that is regularly traded on Bursa Malaysia or an established stock exchange. Non-United States government entity, government-linked or state-owned company. An entity whose revenue is mainly (or at least 50%) derived from its core business activity. eg. Partnerships, manufacturing companies, trading companies. 3. Is there any of your company s shareholders a U.S. citizen or holder of a U.S. permanent residence? If yes, please complete the following: Yes No Name of shareholder Address Tax Residence(s) [If more than one, list all] Tax Identification Number(s) [If more than one, list all] Place of birth (City and country) and date of birth (DD/MM/YYYY) Each of the shareholders listed above has to complete Form W-9. This section is for Passive NFFEs only.

4 Declaration I hereby irrevocably and unconditionally warrant and represent to the Company that, the Company shall have the right to provide personal data and information provided to the Company by me / us and/or acquired by the Company from the public domain, as well as personal data that arises as a result of the provision of services to me / us, to any governmental authorities, regulatory bodies and/or any other relevant person(s) in respect of the Reporting Requirements. I hereby acknowledge and agree that such disclosures may involve the transfer of personal data outside of Malaysia and that such disclosures may include but is not limited to any information relating to, arising from and/or in connection with the provision of the services which we have requested, and our investments with the Company. Under penalties of perjury, I declare that we have examined the information on this form and to the best of our knowledge and belief it is true, correct, and complete. I undertake to notify the recipient of any change in circumstances that causes any certification on this form to become incorrect and to provide a suitably updated form within 30 days of such change. I certify that I have the capacity to sign for the entity / corporation. Definitions 1) Registered Deemed Compliant Foreign Financial Institution ( RDCFFI ) includes local FFI, non-reporting member of PFFI groups, qualified collective investment vehicles, restricted funds, qualified credit card issuers, sponsored investment entities and controlled foreign corporations. 2) 3) 4) 5) Certified Deemed Compliant Foreign Financial Institution ( DCFFI ) includes non-registering local bank, FFI with low value accounts, sponsored closely held investment vehicles, or limited life debt investment entities. Owner-Documented Foreign Financial Institution ( ODFFI ) includes an FFI that meets certain specified requirements, including (i) the FFI must be an FFI solely because it is an investment entity, (ii) generally, the FFI s withholding agent must be a US financial institution or participating FFI, (iii) the withholding agent must agree to satisfy the FFI s reporting requirements with respect to any specified US persons who hold an interest in the FFI; and (iv) the FFI must provide its withholding agent with certain specified information, including a withholding certificate identifying the FFI as an owner-documented FFI that is not acting as an intermediary. Exempt beneficial owner ( EBO ) includes a foreign government, a government of a U.S. possession, an international organisation, a central bank of issue, a retirement fund, or an entity wholly owned by an exempt beneficial owner. passive income includes investment income, such as dividends, interest, rents and royalties (other than certain active rents and royalties), annuities, the excess of gains over losses from the sale or exchange of the foregoing types of property, etc. 6) substantial US shareholders includes any specified US person owning 10% or more, directly or indirectly, of control of or ownership in the applicant. DECLARATION AND SIGNATURE(S) I / We hereby acknowledge and agree to be responsible for ensuring the accuracy and completeness of the information provided in this form and I / we shall not hold Affin Hwang Asset Management Berhad ("Affin Hwang AM") responsible and liable for any losses suffered by me / us due to inaccurate information provided herein. I / We acknowledge and accept that has absolute discretion to rely on the information and/or instruction provided herein from me / us and I / we undertake to indemnify and hold harmless, its employees, agents against all cost, liabilities, claims and demands arising out of the information and/or instruction provided herein. Signature of Authorised Signatory Date: Signature of Authorised Signatory(ies) Date:

5 APPENDIX Code for Nature of Business: Code NATURE OF BUSINESS A01 Cash intensive business ie. where the business receives payments for services and/or goods sold in physical cash (eg. convenience store, restaurants, car parking service, car workshops, car wash centres, beauty salons, petrol kiosks, laundry service, etc) A02 Casino, betting and other gambling related activities A03 Night club, karaoke, lounge, sauna, bar A04 Money service business (eg. non-bank money changers, non-bank money remittance service providers, non-bank currency wholesalers, etc) A05 Dealers (both individual and corporate) in valuable or precious goods (jewels, gems, art, antique, real estate) A06 Pawnshop A07 Arms or weapon related business A08 Snooker centre A09 Internet café operator A10 Forwarding agents A11 Unregulated hedge fund A12 Private banking A13 Offshore banking or offshore trust A14 Charity A15 Non-governmental organisation (NGO) A16 Company incorporation agents A17 More than one of the above A18 None of the above V4 2016