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SFL_FATCA_Declaration_Form

The FATCA-Declaration Form requires primary and co-applicants to provide identification details, tax residency declarations, and confirm the accuracy of the information submitted. Applicants must indicate their tax residency status, including options for Indian residents or those from other countries, and provide relevant tax identification numbers. The document also outlines the terms and conditions related to compliance with tax regulations and the importance of updating any changes in information promptly.

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13 views3 pages

SFL_FATCA_Declaration_Form

The FATCA-Declaration Form requires primary and co-applicants to provide identification details, tax residency declarations, and confirm the accuracy of the information submitted. Applicants must indicate their tax residency status, including options for Indian residents or those from other countries, and provide relevant tax identification numbers. The document also outlines the terms and conditions related to compliance with tax regulations and the importance of updating any changes in information promptly.

Uploaded by

gouravkapil431
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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FATCA-Declaration Form

*Mandatory Fields

Primary Applicant:

11) Identification Type and Identification Number (Documents 1 submitted as per proof of identity of the individual): Name of the document submitted

__________________________ Identification number ______________________


12) Please tick applicable tax resident declaration: (Any one)*
I am a tax resident of India and not resident of any other country
or
I am a tax resident of the country/ies mentioned in the table below

Country* Tax identification Number% Identification Type (TIN or Other%, please specify)

#To also include USA, where the individual is a citizen/green card holder of USA
%In case Tax Identification No. is not available, kindly provide functional equivalents
1
permissible documents are • Passport • Election ID Card • PAN Card • Driving License • UIDAI Card • NREGA Job Card • Others

FATCA-CRS Certification
I have understood the information requirements of this Form (and Terms & Conditions) and hereby confirm that the information provided by me on this Form is true, correct, and complete
and hereby accept the same.

Signature:

Date : ____________________ Place : _________________________


Co-Applicant 1:

11) Identification Type and Identification Number (Documents 1 submitted as per proof of identity of the individual): Name of the document submitted

__________________________ Identification number ______________________

12) Please tick applicable tax resident declaration: (Any one)*

I am a tax resident of India and not resident of any other country


or
I am a tax resident of the country/ies mentioned in the table below

Country* Tax identification Number% Identification Type (TIN or Other%, please specify)

#To also include USA, where the individual is a citizen/green card holder of USA
%In case Tax Identification No. is not available, kindly provide functional equivalent$
1
permissible documents are • Passport • Election ID Card • PAN Card • Driving License • UIDAI Card • NREGA Job Card • Others

FATCA-CRS Certification
I have understood the information requirements of this Form (and Terms & Conditions) and hereby confirm that the information provided by me on this Form is true, correct, and complete
and hereby accept the same.

Signature:

Date : ____________________ Place : _________________________


Co-Applicant 2:

11) Identification Type and Identification Number (Documents 1 submitted as per proof of identity of the individual): Name of the document submitted

________________________________Identification number_____________________________________

12) Please tick applicable tax resident declaration: (Any one)*

I am a tax resident of India and not resident of any other country


or
I am a tax resident of the country/ies mentioned in the table below

Country* Tax identification Number% Identification Type (TIN or Other%, please specify)

#To also include USA, where the individual is a citizen/green card holder of USA
%In case Tax Identification No. is not available, kindly provide functional equivalents
1
permissible documents are • Passport • Election ID Card • PAN Card • Driving License • UIDAI Card • NREGA Job Card • Others

FATCA-CRS Certification
I have understood the information requirements of this Form (and Terms & Conditions) and hereby confirm that the information provided by me on this Form is true, correct, and complete
and hereby accept the same.

Signature:

Date : ____________________ Place : _________________________

FATCA-CRS Terms and Conditions


The Central Board of Direct Taxes has notified on 7th August 2015 Rules 114F to 114H, as part of the Income-tax Rules, 1962, which Rules require Indian financial institutions such as the Bank/other Financial Institutions to
seek additional personal, tax and beneficial owner information and certain certifications and documentation from all our account holders. In relevant cases, information will have to be report to tax authorities/ appointed
agencies/ with holding agents for the purpose of ensuring appropriate withholding from the account or any proceeds in relation thereto. Should there be any change in any information provided by you, please insure you
advise us promptly, i.e. within 30 days. If you have any questions about your tax residency. please contact your tax advisor. If you are a US citizen or resident or green card holder, please include United States in the foreign
country information field along with your US Tax Identification Number. It is mandatory to supply a TIN or functional equivalent if the country in which you are tax resident issue such identifiers. If no TIN is yet available or has
not yet been issued, please provide an explanation and attach this to the form.

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