Tax Residency Self-certification Form: Corporate

Transcription

1 FNB Securities Head Office: 4 Merchant Place 1 Fredman Drive Sandton 2196 PO Box 3359 Parklands 2121 fnbsecurities@fnb.co.za Dealing Desk: Tax Residency Self-certification Form: Corporate FNB Securities (Pty) Ltd ( FNB Securities ) is an authorised user of the Johannesburg Stock Exchange (JSE) and a Financial Services Provider ( FSP ) in terms of the Financial Advisory and Intermediary Services Act, 37 of 2002, with FSP number 182. Instruction Due to various legislative requirements, the South African Revenue Service ( SARS ) requires FNB Securities to attain your certified Foreign Account Tax Compliance Act ( FATCA ) / Common Reporting Standard ( CRS ) classification and to collect and report certain information about an account holder s tax residency status. If you (or the account holder on whose behalf you are completing the form) have a tax obligation or tax residence outside of South Africa, FNB Securities is legally obliged to pass on the information in this form to SARS. 1. This form must be completed on behalf of an entity account holder. 2. If the institution operates in the United States of America (U.S.) or was incorporated/ registered in the U.S. please also complete an IRS W-9 form found on the IRS website. 3. Please ensure that all fields are completed and that the annexure at the end of this form is also completed by all controlling persons of the account holder. 4. A branch of an entity is treated in its own right for the purposes of FATCA and CRS and the form should be completed with details for the branch to which the account relates and not that of its parent. 5. As a financial institution, FNB Securities is not allowed to give tax advice, if you have any questions about this form or defining your tax residency status, please speak to your tax advisor or local tax authority. You can also find out more at the Organisation for Economic Co-operation and Development ( OECD ) automatic exchange of information portal. In terms of FATCA and CRS, it is law for us to ask for the information requested. You may decline the request to provide the information, however, should the requested information not be provided we advise that we will be required to report the undocumented status of the account to SARS and the account may be subject to penalties for non-compliance. Additionally, should this be a new account application, we will not be able to accept the investment without the required information due to legislative reasons. 1. Basic Investor details Entity details Registration name Registration number/trust number (if applicable) Physical address Country Please list all of your tax registration details below, including any jurisdiction in which you may be liable for tax Directors: H Mojalefa, PP Dreyer, W Myers, V Naidoo. Company Secretary: C Low Page 1 of 6

2 If this entity is a Financial Institution, please complete this section and provide the relevant IRS W-8 form. Please provide the account holder s status by ticking one of the following boxes: A. An investment entity that has appointed another Financial Institution in a fiduciary capacity to manage its investment activities or operations on a discretionary basis (please complete Annexure A: Controlling Persons ) B. Other investment entity C. Other Financial Institutions (i.e. depository institution, custodial institution, or specified insurance company) Please provide the entity s Global Intermediary Identification (GIIN): If the entity does not have a GIIN but is sponsored by another entity which has a GIIN, please provide the following: Sponsor s GIIN: Sponsor s Name: If the entity does not have a GIIN or cannot provide a GIIN from a Sponsor, please specify the reason by providing the organization s classification below: Classification Tick Classification Tick 1. Participating Financial Institution (FI), which has applied for a GIIN but has not yet received a GIIN. 2. Exempt Beneficial Owner (e.g. international organization) 3. Certified Deemed Compliant FI (e.g. investment advisor) 5. Non-reporting FI (e.g. trustee documented trust) 6. Non-Participating FI 7. Limited FI 4. Owner Documented FI 8. Other, please specify below (only tick if the entity type is Other: 2. Financial Institutions contained within your local jurisdiction legislation where you are tax resident) If you do not know the entity s classification and have not provided a GIIN, please complete the relevant IRS W-8 form found on the IRS website 3. Non-Financial Entities Please note that the definitions of all terms used in sections 3 and 4 are available on FNB Securities website. If you are not a FI, please complete this section to assist us in determining your status for FATCA and CRS purposes. FATCA Classification* If you already know your classification for FATCA purposes, please select the applicable box below and disregard the remaining questions in this section only. Active NFE Passive NFE (please complete Annexure A for all Controlling Persons) Exempt Beneficial Owner Direct/Sponsored Direct Reporting NFE (please supply the relevant GIIN below) Direct/Sponsored NFE GIIN: Trusts* If you are a trust and have not provided your FATCA classification above, please complete all the questions that follow in this section (1-10), otherwise please move on to question 5: 1. Has a financial institution been appointed in a fiduciary capacity to carry out the day to day functions of the entity and therefore the entity can be seen to be professionally managed by another financial institution? Yes No 2. Name of the financial institution (if applicable): 3. GIIN of the financial institution (if applicable): 4. Country of operation of managing Financial Institution: Note: by providing a controlling financial institution with their GIIN you are certifying that you are a trustee-documented trust. Directors: H Mojalefa, PP Dreyer, W Myers, V Naidoo. Company Secretary: C Low Page 2 of 6

3 All Entities (including trusts)* If you are not a trust and have not provided your FATCA classification above, please answer the remaining questions. 5. Are you a: Retirement Fund Government or wholly government owned Central Bank International Organisation None of the above Note: by selecting one of the above, you confirm that you are an Exempt Beneficial Owner 6. Are you a listed company on an established securities market? Listed company Entity related to a listed entity 7. Are you a Non-profit organisation with a tax clearance certificate? Yes No 8. Are you a treasury centre or holding company of a non-financial group? Yes No Unlisted entity (and not related to a listed entity) 9. Did less than 50% of the entity s gross income, for its previous reporting period or calendar year, come from a passive source (e.g. interest, dividends, rentals, royalties, etc.)? Yes No 10. Less than 50% of the assets held by the entity during the previous reporting period or calendar year produced passive income or are otherwise held for the production of passive income? Yes No Note: if you have selected Listed company or entity related to a listed entity in question 6 above, or you answered Yes to any of the questions 7 to 10, you are certifying that you are an Active Non-Financial Entity. If the opposite is true, you are certifying that you are a Passive Non-financial Entity and are therefore required to provide us with details on your controlling persons. Please complete Annexure A Controlling person details, at the end of this form. Important note: should you disagree with this assessment, please supply the correct FATCA classification at the beginning of this section of the form or complete and submit the relevant IRS W-8 or W-9 form found on the IRS website. 4. Your declarations 1. You the authorized parties/signatories hereby confirm that the information provided is true and correct, that the entity as disclosed above holds no other residences for tax purposes other than those disclosed in this form and will inform FNB Securities in writing of any change of this status within 30 (thirty) days of the change of status. 2. You, the authorised party/signatory, hereby confirm that the controlling persons information provided is true and correct and such controlling persons hold no other citizenships and residencies for tax purposes other than those disclosed in Annexure A to this form and will inform FNB Securities in writing of any change of this status within 30 days of the change of status. 3. You hereby confirm that all information provided has been done so voluntarily and on your own accord. 4. You confirm that should the information provided be incorrect or untrue, you may be held personally or jointly liable (as the case may be) for any penalties or criminal charges that may be imposed by the regulator due to information you provided. 5. You confirm and consent as necessary that FirstRand Limited together with its affiliates and wholly owned subsidiaries as defined in terms of the Companies Act 71 of 2008, may process (collect, use or otherwise deal with) your information (including processing of your personal information outside the borders of South Africa), which was voluntarily provided by yourself, for the purposes of providing services and products, according to the Terms and Conditions and requirements of the law. 6. You hereby indemnify FNB Securities against any liability for any loss or damage suffered by me as a result of inaccurate or incomplete information contained herein. Signed at on this day of 20 The Client (Full name of entity) Signature of Client/authorised signatory on behalf of Client Name of authorised signatory, who warrants his authority Signed at on this day of 20 FNB Securities representative (Full names of duly authorised signatory) Signature of FNB Securities representative Signed at on this day of 20 Wealth Manager (if applicable) (Full names of duly authorised signatory) Signature of Wealth Manager Directors: H Mojalefa, PP Dreyer, W Myers, V Naidoo. Company Secretary: C Low Page 3 of 6

4 Annexure A. Controlling person details If you are a Passive Non-financial Entity or you are an investment entity, managed by a financial institution, please ensure that this annexure is completed for all controlling persons of the account holder. Controlling persons are defined as natural persons who exercise control over an Entity. In the case of a trust such term means: A. Trustee; B. Founder; C. Settlor; D. Protector; E. Beneficiaries (or class of beneficiaries); and F. Via other means. In the case of a legal arrangement other than a trust, such term means persons in equivalent or similar positions. Generally controlling persons include: A. Directors/Partners; B. Shareholders; C. Founder; D. Senior managing official; and E. Via other means. Please note that should another entity effect control over the account holder, we will require a company organogram to inform us of the company structure. Additionally, we may request additional details in order to determine the ultimate beneficial owners of the assets, due to legislative reasons. Should there be more than 5 controlling persons, please complete an additional Annexure A. Full name Name of entity controlled Relationship (e.g. Trustee) Identity/Registration number Shareholding (%) A. B. C. D. E. 100% In respect of A the following must be completed: Date of Birth No Tax registration number Tax identification number country of issue Directors: H Mojalefa, PP Dreyer, W Myers, V Naidoo. Company Secretary: C Low Page 4 of 6

5 In respect of B the following must be completed: In respect of C the following must be completed: Directors: H Mojalefa, PP Dreyer, W Myers, V Naidoo. Company Secretary: C Low Page 5 of 6

6 In respect of D the following must be completed: In respect of E the following must be completed: Directors: H Mojalefa, PP Dreyer, W Myers, V Naidoo. Company Secretary: C Low Page 6 of 6