Print. 1. Entity details
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1 Self-certification under the Austrian Common Reporting Standard Act (GMSG) and the Foreign Account Tax Compliance Act (FATCA) for entities- individuals Under the Agreement between the Republic of Austria and the United States of America for Cooperation to Facilitate the Implementation of FATCA, is obligated to identify specific accounts of US persons and/or of non-us passive entities controlled by US persons as well as accounts of, or obligations to, financial institutions not participating in the FATCA scheme, and, if necessary, to make a report to the US tax authorities as necessary. Furthermore, the Common Reporting Standard Act (Gemeinsamer Meldestandard-Gesetz, GMSG) constitutes the translation into Austrian law of the automatic exchange of information or Common Reporting Standard (CRS) developed by the OECD as a global standard. So far, almost 100 participating jurisdictions have committed to the aim of this worldwide regulation, which is to combat tax evasion. Financial institutions in participating jurisdictions are obligated to check their customers data for indications that the customer s residence for tax purposes is in a different participating jurisdiction. The collected data are reported to the national financial administration, which transmits them to the relevant foreign authority. FATCA and CRS terms are explained below in Clause 6. For legal reasons, is not permitted to provide advice in tax matters - like issues related to FATCA and CRS - or to offer help with filling in the form. If you have any questions, please contact your tax advisor or your tax office. 1. Entity details Name of entity Country of registration Street name, number Postcode, city Country 1
2 2. US tax status Was or is the entity established in the USA or organised under US law or is the entity a US tax resident? Yes, my TIN is No Given US tax residency, i.e. if yes was ticked, IRS Form W-9 from the US Internal Revenue Service and a Consent to Report have to be filled in additionally. In this context, the term entity also comprises US trusts. 3. Indication of residence for tax purposes All countries where the entity is resident for tax purposes have to be stated, together with the tax identification number (TIN) assigned to the entity in the respective jurisdiction of residence. If the entity does not have a TIN in any given jurisdiction of residence, the reason for this must also be set out. Country (written out): Tax identification number (TIN) Country (written out): Tax identification number (TIN) Country (written out): Tax identification number (TIN) Where applicable, state reason why tax identification numbers are missing: 2
3 4. Classification of entity Tick the appropriate box to indicate the entity s status. Clause 6 provides the relevant definitions. If clear and unambiguous classification is not possible, classify the entity as a passive entity (NFE/NFFE). a) Non-financial institutions Active entity (NFE/NFFE): active NFE due to income and assets listed NFE or related entity governmental entity, international organisation or central bank, and/or related entity holding company start-up (e.g. a company being set up) NFE being wound up (in liquidation) Treasury centre of a non-financial group non-profit NFE Passive entity (NFE/NFFE) passive NFE/NFFE (not an active NFE/NFFE) investment entity that is not a financial institution of a jurisdiction participating in the CRS scheme (will be treated like a passive NFE/NFFE) Passive entities have to provide details on the persons controlling them under Clause 5. b) Financial institutions investment entity that is an investment entity other than the above-mentioned. custodial institution, depository institution, or specified insurance company. If you are a financial institution, please disclose the GIIN. GIIN If you are a US-Disregarded Entity under FATCA or a passive UFFE whose owner is a US tax resident, please fill in and submit IRS form W-8BEN-E in addition to the self-certification form! 5. Controlling persons Details on the controlling persons have to be provided only for passive NFEs/NFFEs including investment entities that are treated like passive entities There are no controlling persons. There are controlling persons. 3
4 If there are controlling persons, the following details have to be provided with respect to them: 1. Title, last name(s)/first name(s) 2. Title, last name(s)/first name(s) 3. Title, last name(s)/first name(s) 4. Title, last name(s)/first name(s) 5. Title, last name(s)/first name(s) 4
5 6. Title, last name(s)/first name(s) 7. Title, last name(s)/first name(s) If the current primary residence of one or more of the controlling persons is different from the country of residence for tax purposes, please supply a logical explanation here and attach a relevant document (e.g. a certificate of residence). Are there one or more US persons among the controlling persons? Yes No If US persons are among the controlling persons, a filled-in IRS form W-9 and a Consent Report have to be submitted for each such US person. 5
6 6. Definitions and explanations of terms Entity The term entity means a legal person or a legal arrangement, such as a corporation, partnership, trust, or foundation. NFE/NFFE (Non-Financial Entity/Non-Financial Foreign Entity) An NFE/NFFE means any entity that is not a financial institution. Active entity (NFE/NFFE) Entity that can be classified as belonging to at least one of the following categories: Active NFE due to income and assets Less than 50 % of the NFE's gross income for the preceding calendar year is passive income and less than 50 % of the assets held by the NFE during the preceding calendar year are assets that produce or are held for the production of passive income. Listed NFE or related entity The stock of the NFE is regularly traded on an established securities market or the NFE is a related entity of an entity the stock of which is regularly traded on an established securities market. Governmental entity, international organisation or central bank, and/or related entity The NFE is a governmental entity, an international organisation, a central bank, or an entity wholly owned by one or more of the foregoing. Holding company Substantially all of the activities of the NFE consist of holding (in whole or in part) the outstanding stock of, or providing financing and services to, one or more subsidiaries that engage in trades or businesses other than the business of a financial institution, except that an entity does not qualify for this status if the entity functions (or holds itself out) as an investment fund, such as a private equity fund, venture capital fund, leveraged buyout fund, or any investment vehicle whose purpose is to acquire or fund companies and then hold interests in those companies as capital assets for investment purposes. Start-up company (e.g. a company being set up) The NFE is not yet operating a business and has no prior operating history, but is investing capital into assets with the intent to operate a business other than that of a financial institution, provided that the NFE does not qualify for this exception after the date that is 24 months after the date of the initial organisation of the NFE. NFE being wound up (in liquidation) The NFE was not a financial institution in the past five years, and is in the process of liquidating its assets or is reorganising with the intent to continue or recommence operations in a business other than that of a financial institution. Treasury centre of a non-financial group The NFE primarily engages in financing and hedging transactions with, or for, related entities that are not financial institutions, and does not provide financing or hedging services to any entity that is not a related entity, provided that the group of any such related entities is primarily engaged in a business other than that of a financial institution. 6
7 Non-profit NFE The NFE meets all of the following requirements: It is established and operated in its jurisdiction of residence exclusively for religious, charitable, scientific, artistic, cultural, athletic, or educational purposes; or it is established and operated in its jurisdiction of residence and it is a professional organisation, business league, chamber of commerce, labour organisation, agricultural or horticultural organisation, civic league or an organisation operated exclusively for the promotion of social welfare. It is exempt from income tax in its jurisdiction of residence. It has no shareholders or members who have a proprietary or beneficial interest in its income or assets. The applicable laws of the NFE's jurisdiction of residence or the NFE's formation documents do not permit any income or assets of the NFE to be distributed to, or applied for the benefit of, a private person or non-charitable entity other than pursuant to the conduct of the NFE's charitable activities, or as payment of reasonable compensation for services rendered, or as payment representing the fair market value of property which the NFE has purchased. The applicable laws of the NFE's jurisdiction of residence or the NFE's formation documents require that, upon the NFE's liquidation or dissolution, all of its assets be distributed to a governmental entity or other non-profit organisation, or escheat to the government of the NFE's jurisdiction of residence or any political subdivision thereof. Passive entity (NFE/NFFE) The term passive NFE means any NFE that is not an active NFE; or an investment entity that is not a financial institution of a jurisdiction participating in the CRS scheme. Financial institution The term financial institution means a custodial institution, a depository institution, an investment entity, or a specified insurance company. Custodial institution The term custodial institution means any entity that holds, as a substantial portion of its business, financial assets for the account of others. Depository institution The term depository institution means any entity that accepts deposits in the ordinary course of a banking or similar business. Investment entity The term investment entity means any entity which primarily conducts as a business one or more of the following activities or operations for or on behalf of a customer: trading in money market instruments (cheques, bills, certificates of deposit, derivatives, etc.); foreign exchange; exchange, interest rate and index instruments; transferable securities; or commodity futures trading, 7
8 or individual and collective portfolio management, or otherwise investing, administering, or managing financial assets or money on behalf of other persons the gross income of which is primarily attributable to investing, reinvesting, or trading in financial assets, if the entity is managed by another entity that is a depository institution, a custodial institution, a specified insurance company, or itself an investment entity Specified insurance company The term specified insurance company means any entity that is an insurance company (or the holding company of an insurance company) which issues, or is obligated to make payments with respect to, a cash value insurance contract or an annuity contract. Controlling persons The term controlling persons means the natural persons who exercise control over an entity. In the case of a trust, that term means the settlor(s), the trustee(s), the protector(s) (if any), the beneficiary(ies) or class(es) of beneficiaries, and any other natural person(s) exercising ultimate effective control over the trust. In all other cases, control over an entity is usually exercised by the natural person(s) that ultimately has/have a dominant ownership position with respect to the entity - for instance, based on a specific shareholding level. If control is not exercised through an equity interest, the controlling persons are those persons that exercise control over the entity by other means or the natural persons holding an executive management position. Related entity An entity is a related entity of another entity if either entity controls the other entity; the two entities are under common control; or the two entities are investment entities, are under common management, and such management fulfils the due diligence obligations of such investment entities. For this purpose, control includes direct or indirect ownership of more than 50 % of the vote and value in an entity. TIN (Taxpayer Identification Number) The TIN is a personal identification number that is or can be issued, for tax purposes, to natural persons and legal persons by the tax administration of the jurisdiction of residence. It must not be confused with the VAT registration number, which is not permitted to be used for the purposes of FATCA and CRS. GIIN (Global Intermediary Identification Number) The GIIN is an identification number for financial intermediaries that is issued for FATCA purposes by the US Internal Revenue Service (IRS) upon the registration of a financial institution. 8
9 7. Declaration and signature We acknowledge that, based on the provisions of the Austrian Common Reporting Standard Act (GMSG) and subject to certain conditions, entity data (including, in certain cases, data with respect to the controlling persons) as well as account-related data, will be reported to the respective tax authority(ies) and transmitted, where necessary, to the tax authorities of the respective jurisdiction(s) of residence. We declare in lieu of an oath and confirm that we have verified all the details stated in this form and that, to the best of our knowledge and belief, they are true, complete and correct. We undertake to notify of any changes in these details in writing without delay. Place, date Name of entity Authorised signature (company stamp, signatures) and name(s) of the undersigned legal representative(s) 9
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