International Tax Compliance Regulations under Common Reporting Standard(CRS) SELF CERTIFICATION FORM -INDIVIDUAL
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5 (Authorised by the Prudential Regulation Authority (PRA) and regulated by the Financial Conduct Authority and PRA) Corporate Office: 1 Moorgate, London EC2R 6JH Customer support: FAX: customersupport@pnbint.com Website: International Tax Compliance Regulations under Common Reporting Standard(CRS) SELF CERTIFICATION FORM -INDIVIDUAL Regulations in the UK based on the United States Foreign Account Tax Compliance Act ( FATCA ) and the OECD s Common Reporting Standard ( CRS ) require Punjab National Bank (International) Limited to collect and report certain information about an account holder s tax residence. Each jurisdiction has its own rules for defining tax residence, and jurisdictions have provided information on how to determine if you are resident in the jurisdiction. In general, you will find that tax residence is the country/jurisdiction in which you live. Special circumstances may cause you to be resident elsewhere or resident in more than one country/jurisdiction at the same time (dual residency). If you are a U.S. citizen or tax resident under U.S. law, you should indicate that you are a U.S. tax resident on this form and you also need to fill in an IRS Form W-9. Please fully complete this form. 1. Personal Details First name(s): Surname: Residence Address: Mailing Address: Date of Birth: / / (DD/MM/YYYY) Place of Birth: (Town/City and Country): 2. Tax Residence (Please encircle whichever is applicable) a) Are you a US citizen or tax resident? Yes/No b) Do you have any tax residency other than UK? Yes/No If you have answered yes to a) then please provide your U.S. tax identification number in the table below as well as please provide an IRS Form W-9 in addition to this form. If you have answered yes to b) please provide all your countries of tax residence (including of UK) and associated tax identification numbers in the in the table below. If you are having only UK tax residency, you need to provide your tax identification number for UK only. Corporate Office: 1, Moorgate, City Of London, EC2R 6JH We are a call away, please call Customer Support Number: , (Monday to Friday, 0900AM to 0500 PM) customersupport@pnbint.com
6 (Authorised by the Prudential Regulation Authority (PRA) and regulated by the Financial Conduct Authority and PRA) Corporate Office: 1 Moorgate, London EC2R 6JH Customer support: FAX: customersupport@pnbint.com Website: Countries of tax residence Tax Identification Number (TIN)* Reason for no TIN** *For UK residents, the Tax Identification Number shall be your National Insurance Number (NINO). **If you do not have a tax identification number, please provide one of the following reasons in the above table: Reason A - The country/jurisdiction where you are resident does not issue TINs to its residents. Reason B - You are otherwise unable to obtain a TIN or equivalent number. (Please explain why you are unable to obtain a TIN in the below table if you have selected this reason). Reason C - No TIN is required. (Note: Only select this reason if the domestic law of the relevant jurisdiction does not require the collection of the TIN issued by such jurisdiction). 3. Declaration I declare that all statements made in this declaration are, to the best of my knowledge and belief, correct and complete. I undertake to advise Punjab National Bank (International) Limited within 30 days of any change in circumstances which affects my tax residency status or causes the information contained herein to become incorrect or incomplete, and to provide Punjab National Bank (International) Limited with a suitably updated self-certification and Declaration within 30 days of such change in circumstances. Signature: Name: Date: Corporate Office: 1, Moorgate, City Of London, EC2R 6JH We are a call away, please call Customer Support Number: , (Monday to Friday, 0900AM to 0500 PM) customersupport@pnbint.com
(Authorised by the Prudential Regulation Authority (PRA) and regulated by the Financial Conduct Authority and PRA) Corporate Office: 1 Moorgate, Londo
(Authorised by the Prudential Regulation Authority (PRA) and regulated by the Financial Conduct Authority and PRA) Corporate Office: 1 Moorgate, London EC2R 6JH Customer support: 08008499229 FAX: 020 7796
(Authorised by the Prudential Regulation Authority (PRA) and regulated by the Financial Conduct Authority and PRA) Corporate Office: 1 Moorgate, Londo
(Authorised by the Prudential Regulation Authority (PRA) and regulated by the Financial Conduct Authority and PRA) Corporate Office: 1 Moorgate, London EC2R 6JH Customer support: 08008499229 FAX: 020 7796
2. Tax Residence Please provide ALL countries of tax residence of the entity and associated tax identification number ( TIN ) for each country: Countr
SELF CERTIFICATION FORM: ENTITY To, The Manager Punjab National Bank (International) Limited Branch: Annexure II RE: International Tax Compliance Regulations under Automatic Exchange of Information (AEOI)
For Office Use : CUST ID 1: ACCOUNT NO. 1: CUST ID 2: ACCOUNT NO. 2: Type Of Account. (Applicant 2) First Name. Middle Name. Surname.
For Office Use : (International) Limited (Authorised by the Prudential Regulation Authority and Regulated by the Financial Conduct Authority and the Prudential Regulation Authority) Website:www.pnbinternational.co.uk
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(Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority 1, Moorgate, London, EC2R 6JH Tel: + 44 (0) 20 7796 9600 Fax:
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