FATCA Form - Non Individual Clients
FATCA Form - Non Individual Clients
Note – The information in this section is being collected in order to fully comply with Foreign Account Tax Compliance
Act (FATCA) requirements and the Common Reporting Standards (CRS) requirements.
For more information refer:
http://www.irs.gov/Businesses/Corporations/Foreign-Account-Tax-Compliance-Act-FATCA
http://www.oecd.org/ctp/exchange-of-tax-information/automatic-exchange-financial-account-information-common-
reporting-standard.pdf
FATCA / CRS declaration and details for entities
(We are unable to provide advice about your FATCA classification or interpretation of any terms. Please therefore seek
advice from a tax professional on any FATCA aspects)
Part A – Preliminary details (All fields mandatory)
Sr No Particulars Details of Applicant
1 Name of the Entity
2 Entity PAN
3 Address for Tax Residence
(including city, state, country and pin code)
Yes □ No □
b. Is the entity a Specified US Person Entity‘s Exemption Code: ______
(Refer Instruction ―5‖ in the Annexure)
< If yes, please specify city and country of incorporation / formation>>
c. Is the entity formed/incorporated outside India Yes □
City Country
No □
<< If yes, please provide the following details>>
d. Is the entity having Tax Residency in any
Yes □ Country of PAN/ Tax Identification
country(ies) other than India Tax Identification No.
Residency (TIN equivalent) of Type#
the foreign country
No □
Part C– If your answer to question 8 in Part A is a YES, please provide following details:
2. _______________
(Please go to “Declaration and Acknowledgment”)
2 Are you a related entity#of a listed company Yes □ No □
mentioned in Part C (1) above
Nature of relation with the (Please fill ―C3‖)
related entity:
# Related entity – An entity is a related entity of
□ Subsidiary of the listed
another entity if either entity controls the other
company.
entity or the two entities are under common
control. For this purpose, control includes direct □ Controlled by the listed
company.
or indirect ownership of more than 50% of the
votes and value in an entity. If yes, please provide name of the related entity that
is listed :
Name of the stock exchange where the shares of the
related listed entity are regularly traded:
1.
(Please go to ―Declaration and Acknowledgement‖.)
3 Entity is an Active NFFE Please specify nature of business:______________
Active NFFE Code:______________
(Refer codes in Instruction ―3‖ in the Annexure)
(Please Fill Part “D”)
Part D – Controlling Person/Ultimate Beneficial Owner (UBO) Declaration
Provide details of all UBO/s or Controlling person/s, [natural persons as per PMLA] (including Owner Documented FFI’s[For clarification, refer ‗Other Definitions‘ in the
Annexure]) in the table below
If ‘ Yes’, in addition to the below details , please provide a duly filled form W8BEN E along with FFI Owner Reporting Statement and Auditor’s Letter.
If ‘No’, Please provide below details only.
Controlling Person 1 Controlling Person 2 Controlling Person 3 Controlling Person 4 Controlling Person 5
Name (#)
Country of Birth
City of birth
(Please mention only if
the Country of Birth is
other than India)
Birth Date
Address (include City
State, Country & Pin
code)
Address type for address □ Residential or Business □ Residential or Business □ Residential or Business □ Residential or Business □ Residential or Business
mentioned above □ Residential □ Residential □ Residential □ Residential □ Residential
□ Business □ Business □ Business □ Business □ Business
□ Registered Office □ Registered Office □ Registered Office □ Registered Office □ Registered Office
Nationality
Father’s Name (if PAN
not available)
Spouse’s name (optional)
Telephone/mobile
number with ISD code
PAN
Identification No.
Identification Type (TIN □ Passport □ Passport □ Passport □ Passport □ Passport
or Other, please specify □ PAN □ PAN □ PAN □ PAN □ PAN
the name of document for
above) □ Election / Voter‘s ID card □ Election / Voter‘s ID card □ Election / Voter‘s ID card □ Election/ Voter‘s ID card □ Election / Voter‘s ID card
□ Driving License □ Driving License □ Driving License □ Driving License □ Driving License
□ Aadhaar card/ letter □ Aadhaar card/ letter □ Aadhaar card/ letter □ Aadhaar card/ letter □ Aadhaar card/ letter
□ NREGA Card □ NREGA Card □ NREGA Card □ NREGA Card □ NREGA Card
□ Govt ID Card □ Govt ID Card □ Govt ID Card □ Govt ID Card □ Govt ID Card
□ Others ( pls specify) □ Others ( pls specify) □ Others ( pls specify) □ Others ( pls specify) □ Others ( pls specify)
__________________ __________________ __________________ __________________ __________________
% of beneficial interest /
Ownership /Capital /
Profits.
Controlling Person Type
(#) (Refer Instruction”7”
of the Annexure.)
Gender □ Male □ Male □ Male □ Male □ Male
□ Female □ Female □ Female □ Female □ Female
□ Other_____________ □ Other____________ □ Other____________ □ Other____________ □ Other____________
Occupation Type □ Service □ Service □ Service □ Service □ Service
□ Business □ Business □ Business □ Business □ Business
□ Others □ Others □ Others □ Others □ Others
Country of tax residency*
(#)
Additional details to be filled below ONLY by controlling persons having tax residency/permanent residency/citizenship in any country other than India
including green card
Controlling Person 1 Controlling Person 2 Controlling Person 3 Controlling Person 4 Controlling Person 5
Tax Identification
Number (TIN) (or
functional equivalent) of
Controlling Person for
each country identified in
relation to him/her (#)
Identification Type (TIN
or Other, please specify)
(#)
Note:
A. Submit documentary proof like shareholding pattern duly self-attested by Authorized Signatory / Company Secretary.
B. If number of UBOs are greater than 5 or the space required is insufficient, information in the given format can be given in additional sheets.
C. In case of a multiple intermediaries, please provide the shareholding / controlling structure of each such intermediary/ies.
# These details are mandatory for Passive NFFES.
(*) To include US, where Controlling Person is a US citizen or Green Card holder.
FATCA – CRS Terms and Conditions
The Central Board of Direct Taxes has notified Rules 114F to 114H, as part of the Income-tax Rules, 1962, which Rules require Indian 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 reported to tax authorities / appointed agencies. Towards compliance, we may also be required to provide information to any institutions such as
withholding agents for the purpose of ensuring appropriate withholding from the account or any proceeds in relation thereto.
Towards compliance with tax information sharing laws, such as FATCA and CRS, we would be required to seek additional personal, tax and beneficial owner
information and certain certifications and documentation from our account holders. Such information may be sought either at the time of account opening or any time
subsequently. As may be required by domestic or overseas regulators/ tax authorities, we may also be constrained to withhold and pay out any sums from your
account or close or suspend your account(s).
Should there be any change in any information provided by you, please ensure you advise us promptly, i.e., within 30 days from the date of change in such
information.
If you have any questions about your tax residency, please contact your tax advisor. If any controlling person of the entity is a US citizen or resident or green card
holder, please include United States in the foreign country information field along with the US Tax Identification Number.
Foreign Account Tax Compliance provisions (commonly known as FATCA) are contained in the US Hire Act 2010.
Declaration & I/We have understood the information requirements of this Form (read along with the
Acknowledgement FATCA-CRS Instructions & Definitions) and hereby confirm that the information provided
by us on this Form is True, Correct, Complete and updated, and the submitted documents
are genuine and duly executed. I/We also confirm that I/We have read and understood the
FATCA-CRS Terms and Conditions above and hereby accept the same.
I/We certify that (i) I/We am/are taxable as a (―U.S.‖) person under the laws of the United
States of America or any state or political subdivision thereof or therein, including the
District of Columbia or any other states of the U.S., (ii) an estate the income of which is
subject to U.S. federal income tax regardless of the source thereof. (This clause is
applicable only if the account holder is identified as a U.S. person)
I/We acknowledge that towards compliance with tax information sharing laws, such as
FATCA / CRS, Financial Institution (FI) may be required to seek additional personal, tax
and beneficial owner information and certain certifications and documentation from the
account holder. Such information may be sought either at the time of account opening or
any time subsequently. In certain circumstances (including if FI does not receive a valid
self-certification from me) the FI may be obliged to share information on my account with
relevant tax authorities. Should there be any change in any information provided by me, I
ensure that I will advise FI promptly, i.e., within 30 days.
Towards compliance with such laws, JMF may also be required to provide information to
any institutions such as withholding agents for the purpose of ensuring appropriate
Customer’s Authorised
Person Name withholding from the account or any proceeds in relation thereto. As may be required by
domestic or overseas regulators/ tax authorities, JMF may also be constrained to withhold
Signature and pay out any sums from my/our account or close or suspend my/our account(s).
Designation
Date
Place
1. Financial Institution or Foreign Financial Institution (FFI)- The term FFI means any financial institution that is a:
A. Depository institution:
Accepts deposits in the ordinary course of banking or similar business.
B. Custodial institution:
As a substantial portion of its business, holds financial assets for the account of others
Meaning of Income attributable to holding financial assets and related financial services:
Income attributable to holding financial assets and related financial services means custody, account maintenance, and
transfer fees; commissions and fees earned from executing and pricing securities transactions; income earned from
extending credit to customers with respect to financial assets held in custody by the entity (or acquired through such
extension of credit); income earned on the bid-ask spread of financial assets; fees for providing financial advice with
respect to financial assets held in (or potentially to be held in) custody by the entity; and fees for clearance and
settlement services)
C. Investment entity:
Primarily conducts a business or operates for or on behalf of a customer for any of the following 3 activities-
Trading in money market instruments, foreign exchange, foreign currency, etc.
Individual or collective portfolio management
Investing, administering or managing funds, money or financial asset on behalf of other persons;
Or
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 an investment entity
Explanation - An entity is treated as primarily conducting as a business one or more of the activities described in sub-clause
(A), or an entity’s gross income is primarily attributable to investing, reinvesting, or trading in financial assets for purposes of
sub-clause (B), if the entity’s gross income attributable to the relevant activities equals or exceeds 50 percent of the entity’s
gross income during the shorter of: (i) the three-year period ending on 31 March of the year preceding the year in which the
determination is made; or (ii) the period during which the entity has been in existence.
3. Non-financial Entity (NFFE) – Any entity that is not a financial institution (including a territory NFFE)
Expanded affiliated group is defined to mean one or more chains of members connected through ownership (50% or more,
by vote or value, as the case may be) by a common parent entity if the common parent entity directly owns stock or other
equity interests meeting the requirements in at least one of the other members. Generally, only a corporation shall be treated
as the common parent entity of an expanded affiliated group.
(ii) Passive NFFE
The term passive income means the portion of gross income that consists of:
(1) Dividends, including substitute dividend amounts;
(2) Interest
(3) Income equivalent to interest, including substitute interest and amounts received from or with respect to a pool of
insurance contracts if the amounts received depend in whole or part upon the performance of the pool;
(4) Rents and royalties, other than rents and royalties derived in the active conduct of a trade or business conducted, at least
in part, by employees of the NFFE
(5) Annuities
(6) The excess of gains over losses from the sale or exchange of financial assets that gives rise to passive income described
in this section
(7) The excess of gains over losses from transactions (including futures, forwards, and similar transactions) in any financial
assets
(8) The excess of foreign currency gains over foreign currency losses
(9) Net income from notional principal contracts
(10) Amounts received under cash value insurance contracts
(11) Amounts earned by an insurance company in connection with its reserves for insurance and annuity contracts
(12) Net income from swaps.
But passive income will not include in case of a non-financial entity that acts as a dealer in financial assets, any income
from any transaction entered into in the ordinary course of such dealer‘s business as a dealer.
(iv) Controlling persons
Controlling persons are natural persons who exercise control over an entity.
In the case of a trust, such term means the settlor, the trustees, the protector (if any), the beneficiaries or class of
beneficiaries, and any other natural person exercising ultimate effective control over the trust. In the case of a legal
arrangement other than a trust, such term means persons in equivalent or similar positions.
The term ―Controlling Persons‖ shall be interpreted in a manner consistent with the Financial Action Task Force
recommendations.
Pursuant to guidelines on identification of Beneficial Ownership issued vide RBI circular no. DBOD.AML.BC.
No.71/14.01.001/2012- 13 dated January 18, 2013, persons (other than Individuals) are required to provide details of
Beneficial Owner(s) (‗BO‘). Accordingly, the Beneficial Owner means ‗Natural Person‘, who, whether acting alone or
together, or through one or more juridical person, exercises control through ownership or who ultimately has a controlling
ownership interest of / entitlements to:
i. More than 25% of shares or capital or profits of the juridical person, where the juridical person is a company;
ii. More than 15% of the capital or profits of the juridical person, where the juridical person is a partnership; or
iii. More than 15% of the property or capital or profits of the juridical person, where the juridical person is an
unincorporated association or body of individuals.
Where the client is a trust, the banking company and financial institution, as the case may be, shall identify the beneficial
owners of the client and take reasonable measures to verify the identity of such persons, through the identity of the settler of
the trust, the trustee, the protector, the beneficiaries with 15% or more interest in the trust and any other natural person
exercising ultimate effective control over the trust through a chain of control or ownership.
Where no natural person is identified the identity of the relevant natural person who holds the position of senior managing
official.
(v) U.S. Person
U.S. Person means a United States of America citizen or resident individual, a partnership or corporation organized in the
United States of America or under the laws of the United States of America or any State thereof, a trust if (i) a court within
the United States of America would have authority under applicable law to render orders or judgments concerning
substantially all issues regarding administration of the trust, and (ii) one or more U.S. persons have the authority to control
all substantial decisions of the trust, or an estate of a decedent that is a citizen or resident of the United States of America.
(vi) Specified U.S. person
Direct reporting NFFE will mean an NFFE that elects to report on Form 8966 directly to the IRS certain information about
its direct or indirect substantial U.S. owners, in lieu of providing such information to withholding agents or participating
FFIs with which the NFFE holds a financial account
(viii) Owner documented FFI
An FFI that meets the following requirements:
(A) The FFI is an FFI solely because it is an investment entity;
(B) The FFI is not owned by or related to any FFI that is a depository institution, custodial institution, or specified
insurance company;
(C) The FFI does not maintain a financial account for any non participating FFI;
(D) The FFI provides the designated withholding agent with all of the documentation and agrees to notify the withholding
agent if there is a change in circumstances; and
(E) The designated withholding agent agrees to report to the IRS (or, in the case of a reporting Model 1 FFI, to the relevant
foreign government or agency thereof) all of the information described in or (as appropriate) with respect to any specified
U.S. persons and (2).
Notwithstanding the previous sentence, the designated withholding agent is not required to report information with respect to
an indirect owner of the FFI that holds its interest through a participating FFI, a deemed-compliant FFI (other than an owner-
documented FFI), an entity that is a U.S. person, an exempt beneficial owner, or an excepted NFFE.
ix) Sponsoring Entity
The term sponsoring entity means an entity that registers with the IRS and agrees to perform the due diligence, withholding,
and reporting obligations of one or more FFIs pursuant to § 1.1471–5(f)(1)(i)(F) or (2)(iii).
5. Entity Exemption Code for U.S. persons
Code Sub-category
A An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section
7701(a)(37)
B The United States or any of its agencies or instrumentalities
C A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or
instrumentalities
D A corporation the stock of which is regularly traded on one or more established securities markets, as described in
Reg. section 1.1472-1(c)(1)(i)
E A corporation that is a member of the same expanded affiliated group as a corporation described in Reg. section 1.1472-1(c)(1)(i)
F A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures,
forwards, and options) that is registered as such under the laws of the United States or any state
G A real estate investment trust
H A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under
the Investment Company Act of 1940
I A common trust fund as defined in section 584(a)
J A bank as defined in section 581
K A broker
L A trust exempt from tax under section 664 or described in section 4947(a)(1)
M A tax exempt trust under a section 403(b) plan or section 457(g) plan
6. Entity Constitution Type
Code Category
00 Partnership Firm
01 HUF
02 Private Limited Company
03 Public Company
04 Society
05 AOP /BOI
06 Trust
07 Liquidator
08 LLP
09 Artificial Juridical person
10 Bank
11 Others
7. Controlling Person (UBO) Type/Code
Code Sub-category Description
C01 CP of legal person-ownership Controlling ownership interest of more than:
25% of shares or capital or profits of the juridical person
[Investor], where the juridical person is a company;
15% of the capital or profits of the juridical person
[Investor], where the juridical person is a partnership;
15% of the property or capital or profits of the juridical
person [Investor], where the juridical person is an
unincorporated association or body of individuals.
C02 CP of legal person-other means Natural person exercising control over the juridical person
through other means exercised through voting rights,
agreement, arrangements or in any other manner [In cases
where there exists doubt under UBO-1 to UBO - 3 above as
to whether the person with the controlling ownership
interest is the beneficial owner or where no natural person
exerts control through ownership interests].
C03 CP of legal person-senior managing official Natural person who holds the position of senior managing
official [In case no natural person cannot be identified as
above].
C04 CP of legal arrangement-trust-settlor
C05 CP of legal arrangement--trust-trustee
C06 CP of legal arrangement--trust-protector
C07 CP of legal arrangement--trust-beneficiary The beneficiaries with 15% or more interest in the trust if
they are natural person(s).
C08 CP of legal arrangement--trust-other Natural person(s) exercising ultimate effective control over
the Trust through a chain of control or ownership.
C09 CP of legal arrangement—Other-settlor equivalent
C10 CP of legal arrangement—Other-trustee equivalent
C11 CP of legal arrangement— Other-protector
equivalent
C12 CP of legal arrangement—Other-beneficiary
equivalent
C13 CP of legal arrangement—Other-other equivalent
C14 Unknown