FATCA-CRS Declaration Form Individual

FATCA-CRS Declaration Form Individual
FT001
Details under FATCA and CRS
(Please consult your professional tax advisor for further guidance on your tax residency, if required)
Primary Applicant
1) Name*
2) Existing Customer* N Y If Yes, Customer ID
3) Address For Tax Purposes* Communication Permanent Other (If Other, Please fill below)
4) Other Address*
Landmark City
Pin code State Country
5) Address Type* (a) Residential (b) Business (c) Registered Office
6) PAN* OR FORM 60/61*

7) Father’s Name* mandatory if PAN not provided
8) Nationality*
9) City Of Birth* (mandatory for foreign national or non-resident of India)
10) Country of Birth* (mandatory for foreign national or non-resident of India)

11) Identification Type and Identification Number ( Documents 1 submitted as proof of identity of the individual): Name of the document submitted
___________________ Identification number _________________
12) Please tick the 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 · ID 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 : __________________________

*Mandatory Fields
Joint Applicant 1
1) Name*
4) Other Address*
Landmark City

8) Nationality*

Or
1
Signature:
Date : ________________ Place : __________________________

*Mandatory Fields
Joint Applicant 2
1) Name*
4) Other Address*
Landmark City

8) Nationality*

Or
1
Signature:
Date : ________________ Place : __________________________

*Mandatory Fields
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 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 reported to tax
authorities/ appointed agencies/ withholding 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 ensure 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 greencard 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 issues 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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FATCA-CRS Declaration Form Individual

2) Existing Customer* N Y If Yes, Customer ID

5) Address Type* (a) Residential (b) Business (c) Registered Office

6) PAN* OR FORM 60/61*

9) City Of Birth* (mandatory for foreign national or non-resident of India)

10) Country of Birth* (mandatory for foreign national or non-resident of India)

Date : ________________ Place : __________________________

2) Existing Customer* N Y If Yes, Customer ID

5) Address Type* (a) Residential (b) Business (c) Registered Office

6) PAN* OR FORM 60/61*

9) City Of Birth* (mandatory for foreign national or non-resident of India)

10) Country of Birth* (mandatory for foreign national or non-resident of India)

Date : ________________ Place : __________________________

2) Existing Customer* N Y If Yes, Customer ID

5) Address Type* (a) Residential (b) Business (c) Registered Office

6) PAN* OR FORM 60/61*

9) City Of Birth* (mandatory for foreign national or non-resident of India)

10) Country of Birth* (mandatory for foreign national or non-resident of India)

Date : ________________ Place : __________________________

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