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ANNEX I

DUE DILIGENCE OBLIGATIONS FOR IDENTIFYING AND REPORTING ON U.S. 

REPORTABLE ACCOUNTS AND ON PAYMENTS TO CERTAIN 

NONPARTICIPATING FINANCIAL INSTITUTIONS

I. General.

 

A. [FATCA Partner] shall require that Reporting [FATCA Partner] Financial 

Institutions apply the due diligence procedures contained in this Annex I to identify 

U.S. Reportable Accounts and accounts held by Nonparticipating Financial 

Institutions. 

B. For purposes of the Agreement,

1. All dollar amounts are in U.S. dollars and shall be read to include the 

equivalent in other currencies.

2. Except as otherwise provided herein, the balance or value of an 

account shall be determined as of the last day of the calendar year or other 

appropriate reporting period.

3. Where a balance or value threshold is to be determined as of the 

Determination Date under this Annex I, the relevant balance or value shall be 

determined as of that day or the last day of the reporting period ending 

immediately before the Determination Date, and where a balance or value 

threshold is to be determined as of the last day of a calendar year under this 

Annex I, the relevant balance or value shall be determined as of the last day of 

the calendar year or other appropriate reporting period. 

4. Subject to subparagraph E(1) of section II of this Annex I, an account 

shall be treated as a U.S. Reportable Account beginning as of the date it is 

identified as such pursuant to the due diligence procedures in this Annex I.

5. Unless otherwise provided, information with respect to a U.S. 

Reportable Account shall be reported annually in the calendar year following 

the year to which the information relates.

 

C. As an alternative to the procedures described in each section of this Annex I, 

[FATCA Partner] may permit Reporting [FATCA Partner] Financial Institutions to rely 

on the procedures described in relevant U.S. Treasury Regulations to establish 

whether an account is a U.S. Reportable Account or an account held by a 

Nonparticipating Financial Institution. [FATCA Partner] may permit Reporting

[FATCA Partner] Financial Institutions to make such election separately for each 

section of this Annex I either with respect to all relevant Financial Accounts or, 

separately, with respect to any clearly identified group of such accounts (such as by 

line of business or the location of where the account is maintained). 

II. Preexisting Individual Accounts. The following rules and procedures apply for 

purposes of identifying U.S. Reportable Accounts among Preexisting Accounts held by 
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individuals (“Preexisting Individual Accounts”).

A. Accounts Not Required to Be Reviewed, Identified, or Reported. Unless 

the Reporting [FATCA Partner] Financial Institution elects otherwise, either with 

respect to all Preexisting Individual Accounts or, separately, with respect to any 

clearly identified group of such accounts, where the implementing rules in [FATCA 

Partner] provide for such an election, the following Preexisting Individual Accounts 

are not required to be reviewed, identified, or reported as U.S. Reportable Accounts:

1. Subject to subparagraph E(2) of this section, a Preexisting Individual 

Account with a balance or value that does not exceed $50,000 as of the 

Determination Date.

2. Subject to subparagraph E(2) of this section, a Preexisting Individual 

Account that is a Cash Value Insurance Contract or an Annuity Contract with a 

balance or value of $250,000 or less as of the Determination Date.

3. A Preexisting Individual Account that is a Cash Value Insurance 

Contract or an Annuity Contract, provided the law or regulations of [FATCA 

Partner] or the United States effectively prevent the sale of such a Cash Value 

Insurance Contract or an Annuity Contract to U.S. residents (e.g., if the 

relevant Financial Institution does not have the required registration under 

U.S. law, and the law of [FATCA Partner] requires reporting or withholding 

with respect to insurance products held by residents of [FATCA Partner]).

4. A Depository Account with a balance of $50,000 or less.

B. Review Procedures for Preexisting Individual Accounts With a Balance or 

Value as of the Determination Date, that Exceeds $50,000 ($250,000 for a Cash 

Value Insurance Contract or Annuity Contract), But Does Not Exceed $1,000,000 

(“Lower Value Accounts”).

1. Electronic Record Search. The Reporting [FATCA Partner] Financial 

Institution must review electronically searchable data maintained by the 

Reporting [FATCA Partner] Financial Institution for any of the following U.S. 

indicia:

a) Identification of the Account Holder as a U.S. citizen or 

resident;

b) Unambiguous indication of a U.S. place of birth;

c) Current U.S. mailing or residence address (including a U.S. 

post office box);

d) Current U.S. telephone number;

e) Standing instructions to transfer funds to an account maintained 

in the United States;
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f) Currently effective power of attorney or signatory authority 

granted to a person with a U.S. address; or

g) An “in-care-of” or “hold mail” address that is the sole address 

the Reporting [FATCA Partner] Financial Institution has on file for the 

Account Holder. In the case of a Preexisting Individual Account that is 

a Lower Value Account, an “in-care-of” address outside the United 

States or “hold mail” address shall not be treated as U.S. indicia. 

2. If none of the U.S. indicia listed in subparagraph B(1) of this section 

are discovered in the electronic search, then no further action is required until 

there is a change in circumstances that results in one or more U.S. indicia 

being associated with the account, or the account becomes a High Value 

Account described in paragraph D of this section.

3. If any of the U.S. indicia listed in subparagraph B(1) of this section are 

discovered in the electronic search, or if there is a change in circumstances 

that results in one or more U.S. indicia being associated with the account, then 

the Reporting [FATCA Partner] Financial Institution must treat the account as 

a U.S. Reportable Account unless it elects to apply subparagraph B(4) of this 

section and one of the exceptions in such subparagraph applies with respect to 

that account.

4. Notwithstanding a finding of U.S. indicia under subparagraph B(1) of 

this section, a Reporting [FATCA Partner] Financial Institution is not required 

to treat an account as a U.S. Reportable Account if:

a) Where the Account Holder information unambiguously 

indicates a U.S. place of birth, the Reporting [FATCA Partner] 

Financial Institution obtains, or has previously reviewed and maintains 

a record of:

(1) A self-certification that the Account Holder is neither a 

U.S. citizen nor a U.S. resident for tax purposes (which may be 

on an IRS Form W-8 or other similar agreed form);

(2) A non-U.S. passport or other government-issued 

identification evidencing the Account Holder’s citizenship or 

nationality in a country other than the United States; and

(3) A copy of the Account Holder’s Certificate of Loss of 

Nationality of the United States or a reasonable explanation of: 

(a) The reason the Account Holder does not have 

such a certificate despite relinquishing U.S. citizenship; 

or

(b) The reason the Account Holder did not obtain 

U.S. citizenship at birth.
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b) Where the Account Holder information contains a current U.S. 

mailing or residence address, or one or more U.S. telephone numbers 

that are the only telephone numbers associated with the account, the 

Reporting [FATCA Partner] Financial Institution obtains, or has

previously reviewed and maintains a record of:

(1) A self-certification that the Account Holder is neither a 

U.S. citizen nor a U.S. resident for tax purposes (which may be 

on an IRS Form W-8 or other similar agreed form); and

(2) Documentary evidence, as defined in paragraph D of 

section VI of this Annex I, establishing the Account Holder’s 

non-U.S. status.

c) Where the Account Holder information contains standing 

instructions to transfer funds to an account maintained in the United 

States, the Reporting [FATCA Partner] Financial Institution obtains, or 

has previously reviewed and maintains a record of:

(1) A self-certification that the Account Holder is neither a 

U.S. citizen nor a U.S. resident for tax purposes (which may be 

on an IRS Form W-8 or other similar agreed form); and

(2) Documentary evidence, as defined in paragraph D of

section VI of this Annex I, establishing the Account Holder’s 

non-U.S. status.

d) Where the Account Holder information contains a currently 

effective power of attorney or signatory authority granted to a person 

with a U.S. address, has an “in-care-of” address or “hold mail” 

address that is the sole address identified for the Account Holder, or 

has one or more U.S. telephone numbers (if a non-U.S. telephone 

number is also associated with the account), the Reporting [FATCA 

Partner] Financial Institution obtains, or has previously reviewed and 

maintains a record of:

(1) A self-certification that the Account Holder is neither a 

U.S. citizen nor a U.S. resident for tax purposes (which may be 

on an IRS Form W-8 or other similar agreed form); or

(2) Documentary evidence, as defined in paragraph D of 

section VI of this Annex I, establishing the Account Holder’s 

non-U.S. status.

C. Additional Procedures Applicable to Preexisting Individual Accounts 

That Are Lower Value Accounts.

1. Review of Preexisting Individual Accounts that are Lower Value 

Accounts for U.S. indicia must be completed within two years from the 

Determination Date. 
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2. If there is a change of circumstances with respect to a Preexisting 

Individual Account that is a Lower Value Account that results in one or more 

U.S. indicia described in subparagraph B(1) of this section being associated 

with the account, then the Reporting [FATCA Partner] Financial Institution 

must treat the account as a U.S. Reportable Account unless subparagraph B(4) 

of this section applies.

3. Except for Depository Accounts described in subparagraph A(4) of this 

section, any Preexisting Individual Account that has been identified as a U.S. 

Reportable Account under this section shall be treated as a U.S. Reportable 

Account in all subsequent years, unless the Account Holder ceases to be a 

Specified U.S. Person.

D. Enhanced Review Procedures for Preexisting Individual Accounts With a 

Balance or Value That Exceeds $1,000,000 as of the Determination Date, or 

December 31 of 2015 or Any Subsequent Year (“High Value Accounts”).

1. Electronic Record Search. The Reporting [FATCA Partner] Financial 

Institution must review electronically searchable data maintained by the 

Reporting [FATCA Partner] Financial Institution for any of the U.S. indicia 

described in subparagraph B(1) of this section.

2. Paper Record Search. If the Reporting [FATCA Partner] Financial 

Institution’s electronically searchable databases include fields for, and capture 

all of the information described in, subparagraph D(3) of this section, then no 

further paper record search is required. If the electronic databases do not 

capture all of this information, then with respect to a High Value Account, the 

Reporting [FATCA Partner] Financial Institution must also review the current 

customer master file and, to the extent not contained in the current customer 

master file, the following documents associated with the account and obtained 

by the Reporting [FATCA Partner] Financial Institution within the last five 

years for any of the U.S. indicia described in subparagraph B(1) of this 

section:

a) The most recent documentary evidence collected with respect 

to the account;

b) The most recent account opening contract or documentation;

c) The most recent documentation obtained by the Reporting 

[FATCA Partner] Financial Institution pursuant to AML/KYC 

Procedures or for other regulatory purposes;

d) Any power of attorney or signature authority forms currently in 

effect; and

e) Any standing instructions to transfer funds currently in effect.

3. Exception Where Databases Contain Sufficient Information. A 
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Reporting [FATCA Partner] Financial Institution is not required to perform the 

paper record search described in subparagraph D(2) of this section if the 

Reporting [FATCA Partner] Financial Institution’s electronically searchable 

information includes the following:

a) The Account Holder’s nationality or residence status;

b) The Account Holder’s residence address and mailing address 

currently on file with the Reporting [FATCA Partner] Financial 

Institution;

c) The Account Holder’s telephone number(s) currently on file, if 

any, with the Reporting [FATCA Partner] Financial Institution; 

d) Whether there are standing instructions to transfer funds in the 

account to another account (including an account at another branch of 

the Reporting [FATCA Partner] Financial Institution or another 

Financial Institution);

e) Whether there is a current “in-care-of” address or “hold mail” 

address for the Account Holder; and

f) Whether there is any power of attorney or signatory authority 

for the account. 

4. Relationship Manager Inquiry for Actual Knowledge. In addition 

to the electronic and paper record searches described above, the Reporting 

[FATCA Partner] Financial Institution must treat as a U.S. Reportable Account 

any High Value Account assigned to a relationship manager (including any 

Financial Accounts aggregated with such High Value Account) if the 

relationship manager has actual knowledge that the Account Holder is a 

Specified U.S. Person.

5. Effect of Finding U.S. Indicia.

a) If none of the U.S. indicia listed in subparagraph B(1) of this 

section are discovered in the enhanced review of High Value Accounts 

described above, and the account is not identified as held by a 

Specified U.S. Person in subparagraph D(4) of this section, then no 

further action is required until there is a change in circumstances that 

results in one or more U.S. indicia being associated with the account.

b) If any of the U.S. indicia listed in subparagraph B(1) of this 

section are discovered in the enhanced review of High Value Accounts 

described above, or if there is a subsequent change in circumstances 

that results in one or more U.S. indicia being associated with the 

account, then the Reporting [FATCA Partner] Financial Institution 

must treat the account as a U.S. Reportable Account unless it elects to 

apply subparagraph B(4) of this section and one of the exceptions in 

such subparagraph applies with respect to that account.
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c) Except for Depository Accounts described in subparagraph 

A(4) of this section, any Preexisting Individual Account that has been 

identified as a U.S. Reportable Account under this section shall be 

treated as a U.S. Reportable Account in all subsequent years, unless the 

Account Holder ceases to be a Specified U.S. Person. 

E. Additional Procedures Applicable to High Value Accounts.

1. If a Preexisting Individual Account is a High Value Account as of the 

Determination Date, the Reporting [FATCA Partner] Financial Institution must 

complete the enhanced review procedures described in paragraph D of this 

section with respect to such account within one year from the Determination 

Date. If based on this review such account is identified as a U.S. Reportable 

Account on or before December 31, 2014, the Reporting [FATCA Partner] 

Financial Institution must report the required information about such account 

with respect to 2014 in the first report on the account and on an annual basis 

thereafter. In the case of an account identified as a U.S. Reportable Account 

after December 31, 2014, the Reporting [FATCA Partner] Financial Institution 

is not required to report information about such account with respect to 2014, 

but must report information about the account on an annual basis thereafter.

2. If a Preexisting Individual Account is not a High Value Account as of 

the Determination Date, but becomes a High Value Account as of the last day 

of 2015 or any subsequent calendar year, the Reporting [FATCA Partner] 

Financial Institution must complete the enhanced review procedures described 

in paragraph D of this section with respect to such account within six months 

after the last day of the calendar year in which the account becomes a High 

Value Account. If based on this review such account is identified as a U.S. 

Reportable Account, the Reporting [FATCA Partner] Financial Institution must 

report the required information about such account with respect to the year in 

which it is identified as a U.S. Reportable Account and subsequent years on an 

annual basis, unless the Account Holder ceases to be a Specified U.S. Person.

3. Once a Reporting [FATCA Partner] Financial Institution applies the 

enhanced review procedures described in paragraph D of this section to a High 

Value Account, the Reporting [FATCA Partner] Financial Institution is not 

required to re-apply such procedures, other than the relationship manager 

inquiry described in subparagraph D(4) of this section, to the same High Value 

Account in any subsequent year.

4. If there is a change of circumstances with respect to a High Value

Account that results in one or more U.S. indicia described in subparagraph 

B(1) of this section being associated with the account, then the Reporting 

[FATCA Partner] Financial Institution must treat the account as a U.S. 

Reportable Account unless it elects to apply subparagraph B(4) of this section

and one of the exceptions in such subparagraph applies with respect to that 

account.

5. A Reporting [FATCA Partner] Financial Institution must implement 
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procedures to ensure that a relationship manager identifies any change in 

circumstances of an account. For example, if a relationship manager is 

notified that the Account Holder has a new mailing address in the United 

States, the Reporting [FATCA Partner] Financial Institution is required to treat 

the new address as a change in circumstances and, if it elects to apply 

subparagraph B(4) of this section, is required to obtain the appropriate 

documentation from the Account Holder.

F. Preexisting Individual Accounts That Have Been Documented for Certain 

Other Purposes. A Reporting [FATCA Partner] Financial Institution that has 

previously obtained documentation from an Account Holder to establish the Account 

Holder’s status as neither a U.S. citizen nor a U.S. resident in order to meet its 

obligations under a qualified intermediary, withholding foreign partnership, or 

withholding foreign trust agreement with the IRS, or to fulfill its obligations under 

chapter 61 of Title 26 of the United States Code, is not required to perform the 

procedures described in subparagraph B(1) of this section with respect to Lower Value 

Accounts or subparagraphs D(1) through D(3) of this section with respect to High 

Value Accounts.

III. New Individual Accounts. The following rules and procedures apply for purposes 

of identifying U.S. Reportable Accounts among Financial Accounts held by individuals and 

opened after the Determination Date (“New Individual Accounts”).

A. Accounts Not Required to Be Reviewed, Identified, or Reported. Unless 

the Reporting [FATCA Partner] Financial Institution elects otherwise, either with 

respect to all New Individual Accounts or, separately, with respect to any clearly 

identified group of such accounts, where the implementing rules in [FATCA Partner] 

provide for such an election, the following New Individual Accounts are not required 

to be reviewed, identified, or reported as U.S. Reportable Accounts:

1. A Depository Account unless the account balance exceeds $50,000 at 

the end of any calendar year or other appropriate reporting period. 

2. A Cash Value Insurance Contract unless the Cash Value exceeds 

$50,000 at the end of any calendar year or other appropriate reporting period. 

B. Other New Individual Accounts. With respect to New Individual Accounts 

not described in paragraph A of this section, upon account opening (or within 90 days 

after the end of the calendar year in which the account ceases to be described in 

paragraph A of this section), the Reporting [FATCA Partner] Financial Institution 

must obtain a self-certification, which may be part of the account opening 

documentation, that allows the Reporting [FATCA Partner] Financial Institution to 

determine whether the Account Holder is resident in the United States for tax 

purposes (for this purpose, a U.S. citizen is considered to be resident in the United 

States for tax purposes, even if the Account Holder is also a tax resident of another 

jurisdiction) and confirm the reasonableness of such self-certification based on the 

information obtained by the Reporting [FATCA Partner] Financial Institution in 

connection with the opening of the account, including any documentation collected 

pursuant to AML/KYC Procedures.
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1. If the self-certification establishes that the Account Holder is resident 

in the United States for tax purposes, the Reporting [FATCA Partner] Financial 

Institution must treat the account as a U.S. Reportable Account and obtain a 

self-certification that includes the Account Holder’s U.S. TIN (which may be 

an IRS Form W-9 or other similar agreed form).

2. If there is a change of circumstances with respect to a New Individual 

Account that causes the Reporting [FATCA Partner] Financial Institution to 

know, or have reason to know, that the original self-certification is incorrect or 

unreliable, the Reporting [FATCA Partner] Financial Institution cannot rely on 

the original self-certification and must obtain a valid self-certification that 

establishes whether the Account Holder is a U.S. citizen or resident for U.S. 

tax purposes. If the Reporting [FATCA Partner] Financial Institution is unable 

to obtain a valid self-certification, the Reporting [FATCA Partner] Financial 

Institution must treat the account as a U.S. Reportable Account.

IV. Preexisting Entity Accounts. The following rules and procedures apply for purposes 

of identifying U.S. Reportable Accounts and accounts held by Nonparticipating Financial 

Institutions among Preexisting Accounts held by Entities (“Preexisting Entity Accounts”).

A. Entity Accounts Not Required to Be Reviewed, Identified or Reported. 

Unless the Reporting [FATCA Partner] Financial Institution elects otherwise, either 

with respect to all Preexisting Entity Accounts or, separately, with respect to any 

clearly identified group of such accounts, where the implementing rules in [FATCA 

Partner] provide for such an election, a Preexisting Entity Account with an account 

balance or value that does not exceed $250,000 as of the Determination Date, is not 

required to be reviewed, identified, or reported as a U.S. Reportable Account until the 

account balance or value exceeds $1,000,000.

 

B. Entity Accounts Subject to Review. A Preexisting Entity Account that has

an account balance or value that exceeds $250,000 as of the Determination Date, and 

a Preexisting Entity Account that does not exceed $250,000 as of the Determination 

Date but the account balance or value of which exceeds $1,000,000 as of the last day 

of 2015 or any subsequent calendar year, must be reviewed in accordance with the 

procedures set forth in paragraph D of this section. 

C. Entity Accounts With Respect to Which Reporting Is Required. With 

respect to Preexisting Entity Accounts described in paragraph B of this section, only 

accounts that are held by one or more Entities that are Specified U.S. Persons, or by 

Passive NFFEs with one or more Controlling Persons who are U.S. citizens or 

residents, shall be treated as U.S. Reportable Accounts. In addition, accounts held by 

Nonparticipating Financial Institutions shall be treated as accounts for which 

aggregate payments as described in subparagraph 1(b) of Article 4 of the Agreement 

are reported to the [FATCA Partner] Competent Authority.

D. Review Procedures for Identifying Entity Accounts With Respect to 

Which Reporting Is Required. For Preexisting Entity Accounts described in 

paragraph B of this section, the Reporting [FATCA Partner] Financial Institution must 

apply the following review procedures to determine whether the account is held by 

one or more Specified U.S. Persons, by Passive NFFEs with one or more Controlling 
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Persons who are U.S. citizens or residents, or by Nonparticipating Financial 

Institutions:

1. Determine Whether the Entity Is a Specified U.S. Person.

a) Review information maintained for regulatory or customer 

relationship purposes (including information collected pursuant to 

AML/KYC Procedures) to determine whether the information 

indicates that the Account Holder is a U.S. Person. For this purpose, 

information indicating that the Account Holder is a U.S. Person 

includes a U.S. place of incorporation or organization, or a U.S. 

address.

b) If the information indicates that the Account Holder is a U.S. 

Person, the Reporting [FATCA Partner] Financial Institution must treat 

the account as a U.S. Reportable Account unless it obtains a selfcertification from the Account Holder (which may be on an IRS Form 

W-8 or W-9, or a similar agreed form), or reasonably determines based 

on information in its possession or that is publicly available, that the 

Account Holder is not a Specified U.S. Person.

2. Determine Whether a Non-U.S. Entity Is a Financial Institution.

a) Review information maintained for regulatory or customer 

relationship purposes (including information collected pursuant to 

AML/KYC Procedures) to determine whether the information 

indicates that the Account Holder is a Financial Institution.

b) If the information indicates that the Account Holder is a 

Financial Institution, or the Reporting [FATCA Partner] Financial 

Institution verifies the Account Holder’s Global Intermediary 

Identification Number on the published IRS FFI list, then the account 

is not a U.S. Reportable Account. 

3. Determine Whether a Financial Institution Is a Nonparticipating 

Financial Institution Payments to Which Are Subject to Aggregate 

Reporting Under Subparagraph 1(b) of Article 4 of the Agreement.

a) Subject to subparagraph D(3)(b) of this section, a Reporting 

[FATCA Partner] Financial Institution may determine that the Account 

Holder is a [FATCA Partner] Financial Institution or other Partner 

Jurisdiction Financial Institution if the Reporting [FATCA Partner] 

Financial Institution reasonably determines that the Account Holder 

has such status on the basis of the Account Holder’s Global 

Intermediary Identification Number on the published IRS FFI list or 

other information that is publicly available or in the possession of the 

Reporting [FATCA Partner] Financial Institution, as applicable. In 

such case, no further review, identification, or reporting is required 

with respect to the account.
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b) If the Account Holder is a [FATCA Partner] Financial 

Institution or other Partner Jurisdiction Financial Institution treated by 

the IRS as a Nonparticipating Financial Institution, then the account is 

not a U.S. Reportable Account, but payments to the Account Holder 

must be reported as contemplated in subparagraph 1(b) of Article 4 of 

the Agreement.

c) If the Account Holder is not a [FATCA Partner] Financial 

Institution or other Partner Jurisdiction Financial Institution, then the 

Reporting [FATCA Partner] Financial Institution must treat the 

Account Holder as a Nonparticipating Financial Institution payments 

to which are reportable under subparagraph 1(b) of Article 4 of the 

Agreement, unless the Reporting [FATCA Partner] Financial 

Institution:

(1) Obtains a self-certification (which may be on an IRS 

Form W-8 or similar agreed form) from the Account Holder

that it is a certified deemed-compliant FFI, or an exempt 

beneficial owner, as those terms are defined in relevant U.S. 

Treasury Regulations; or

(2) In the case of a participating FFI or registered deemedcompliant FFI, verifies the Account Holder’s Global 

Intermediary Identification Number on the published IRS FFI 

list.

4. Determine Whether an Account Held by an NFFE Is a U.S. 

Reportable Account. With respect to an Account Holder of a Preexisting 

Entity Account that is not identified as either a U.S. Person or a Financial 

Institution, the Reporting [FATCA Partner] Financial Institution must identify 

(i) whether the Account Holder has Controlling Persons, (ii) whether the 

Account Holder is a Passive NFFE, and (iii) whether any of the Controlling 

Persons of the Account Holder is a U.S. citizen or resident. In making these 

determinations the Reporting [FATCA Partner] Financial Institution must 

follow the guidance in subparagraphs D(4)(a) through D(4)(d) of this section

in the order most appropriate under the circumstances.

a) For purposes of determining the Controlling Persons of an 

Account Holder, a Reporting [FATCA Partner] Financial Institution 

may rely on information collected and maintained pursuant to 

AML/KYC Procedures.

b) For purposes of determining whether the Account Holder is a 

Passive NFFE, the Reporting [FATCA Partner] Financial Institution 

must obtain a self-certification (which may be on an IRS Form W-8 or 

W-9, or on a similar agreed form) from the Account Holder to establish 

its status, unless it has information in its possession or that is publicly 

available, based on which it can reasonably determine that the Account 

Holder is an Active NFFE.
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c) For purposes of determining whether a Controlling Person of a 

Passive NFFE is a U.S. citizen or resident for tax purposes, a 

Reporting [FATCA Partner] Financial Institution may rely on: 

(1) Information collected and maintained pursuant to 

AML/KYC Procedures in the case of a Preexisting Entity 

Account held by one or more NFFEs with an account balance

or value that does not exceed $1,000,000; or

(2) A self-certification (which may be on an IRS Form W-8 

or W-9, or on a similar agreed form) from the Account Holder

or such Controlling Person in the case of a Preexisting Entity 

Account held by one or more NFFEs with an account balance 

or value that exceeds $1,000,000. 

d) If any Controlling Person of a Passive NFFE is a U.S. citizen or 

resident, the account shall be treated as a U.S. Reportable Account.

E. Timing of Review and Additional Procedures Applicable to Preexisting 

Entity Accounts.

1. Review of Preexisting Entity Accounts with an account balance or 

value that exceeds $250,000 as of the Determination Date must be completed 

within two years from the Determination Date.

2. Review of Preexisting Entity Accounts with an account balance or 

value that does not exceed $250,000 as of the Determination Date, but exceeds 

$1,000,000 as of December 31 of 2015 or any subsequent year, must be 

completed within six months after the last day of the calendar year in which 

the account balance or value exceeds $1,000,000.

3. If there is a change of circumstances with respect to a Preexisting 

Entity Account that causes the Reporting [FATCA Partner] Financial 

Institution to know, or have reason to know, that the self-certification or other 

documentation associated with an account is incorrect or unreliable, the 

Reporting [FATCA Partner] Financial Institution must redetermine the status 

of the account in accordance with the procedures set forth in paragraph D of 

this section.

V. New Entity Accounts. The following rules and procedures apply for purposes of 

identifying U.S. Reportable Accounts and accounts held by Nonparticipating Financial 

Institutions among Financial Accounts held by Entities and opened after the Determination 

Date (“New Entity Accounts”). 

A. Entity Accounts Not Required to Be Reviewed, Identified or Reported. 

Unless the Reporting [FATCA Partner] Financial Institution elects otherwise, either 

with respect to all New Entity Accounts or, separately, with respect to any clearly 

identified group of such accounts, where the implementing rules in [FATCA Partner] 

provide for such election, a credit card account or a revolving credit facility treated as 

a New Entity Account is not required to be reviewed, identified, or reported, provided 
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that the Reporting [FATCA Partner] Financial Institution maintaining such account 

implements policies and procedures to prevent an account balance owed to the 

Account Holder that exceeds $50,000.

B. Other New Entity Accounts. With respect to New Entity Accounts not 

described in paragraph A of this section, the Reporting [FATCA Partner] Financial 

Institution must determine whether the Account Holder is: (i) a Specified U.S. 

Person; (ii) a [FATCA Partner] Financial Institution or other Partner Jurisdiction 

Financial Institution; (iii) a participating FFI, a deemed-compliant FFI, or an exempt 

beneficial owner, as those terms are defined in relevant U.S. Treasury Regulations; or 

(iv) an Active NFFE or Passive NFFE. 

1. Subject to subparagraph B(2) of this section, a Reporting [FATCA 

Partner] Financial Institution may determine that the Account Holder is an 

Active NFFE, a [FATCA Partner] Financial Institution, or other Partner 

Jurisdiction Financial Institution if the Reporting [FATCA Partner] Financial 

Institution reasonably determines that the Account Holder has such status on 

the basis of the Account Holder’s Global Intermediary Identification Number 

or other information that is publicly available or in the possession of the 

Reporting [FATCA Partner] Financial Institution, as applicable. 

2. If the Account Holder is a [FATCA Partner] Financial Institution or 

other Partner Jurisdiction Financial Institution treated by the IRS as a 

Nonparticipating Financial Institution, then the account is not a U.S. 

Reportable Account, but payments to the Account Holder must be reported as 

contemplated in subparagraph 1(b) of Article 4 of the Agreement.

3. In all other cases, a Reporting [FATCA Partner] Financial Institution 

must obtain a self-certification from the Account Holder to establish the 

Account Holder’s status. Based on the self-certification, the following rules 

apply:

 

a) If the Account Holder is a Specified U.S. Person, the Reporting 

[FATCA Partner] Financial Institution must treat the account as a U.S. 

Reportable Account.

b) If the Account Holder is a Passive NFFE, the Reporting 

[FATCA Partner] Financial Institution must identify the Controlling 

Persons as determined under AML/KYC Procedures, and must 

determine whether any such person is a U.S. citizen or resident on the 

basis of a self-certification from the Account Holder or such person. If 

any such person is a U.S. citizen or resident, the Reporting [FATCA 

Partner] Financial Institution must treat the account as a U.S. 

Reportable Account.

c) If the Account Holder is: (i) a U.S. Person that is not a 

Specified U.S. Person; (ii) subject to subparagraph B(3)(d) of this 

section, a [FATCA Partner] Financial Institution or other Partner 

Jurisdiction Financial Institution; (iii) a participating FFI, a deemedcompliant FFI, or an exempt beneficial owner, as those terms are 
Model 1 IGA Annex I

November 30, 2014

14

defined in relevant U.S. Treasury Regulations; (iv) an Active NFFE; or 

(v) a Passive NFFE none of the Controlling Persons of which is a U.S. 

citizen or resident, then the account is not a U.S. Reportable Account,

and no reporting is required with respect to the account.

d) If the Account Holder is a Nonparticipating Financial 

Institution (including a [FATCA Partner] Financial Institution or other 

Partner Jurisdiction Financial Institution treated by the IRS as a 

Nonparticipating Financial Institution), then the account is not a U.S. 

Reportable Account, but payments to the Account Holder must be 

reported as contemplated in subparagraph 1(b) of Article 4 of the 

Agreement.

VI. Special Rules and Definitions. The following additional rules and definitions apply 

in implementing the due diligence procedures described above:

A. Reliance on Self-Certifications and Documentary Evidence. A Reporting 

[FATCA Partner] Financial Institution may not rely on a self-certification or 

documentary evidence if the Reporting [FATCA Partner] Financial Institution knows 

or has reason to know that the self-certification or documentary evidence is incorrect 

or unreliable.

B. Definitions. The following definitions apply for purposes of this Annex I.

1. AML/KYC Procedures. “AML/KYC Procedures” means the customer 

due diligence procedures of a Reporting [FATCA Partner] Financial 

Institution pursuant to the anti-money laundering or similar requirements 

of [FATCA Partner] to which such Reporting [FATCA Partner] Financial 

Institution is subject. 

2. NFFE. An “NFFE” means any Non-U.S. Entity that is not an FFI as 

defined in relevant U.S. Treasury Regulations or is an Entity described in 

subparagraph B(4)(j) of this section, and also includes any Non-U.S. 

Entity that is established in [FATCA Partner] or another Partner 

Jurisdiction and that is not a Financial Institution.

3. Passive NFFE. A “Passive NFFE” means any NFFE that is not (i) an 

Active NFFE, or (ii) a withholding foreign partnership or withholding 

foreign trust pursuant to relevant U.S. Treasury Regulations.

4. Active NFFE. An “Active NFFE” means any NFFE that meets any of the 

following criteria:

a) Less than 50 percent of the NFFE’s gross income for the preceding 

calendar year or other appropriate reporting period is passive 

income and less than 50 percent of the assets held by the NFFE 

during the preceding calendar year or other appropriate reporting 

period are assets that produce or are held for the production of 

passive income;
Model 1 IGA Annex I

November 30, 2014

15

b) The stock of the NFFE is regularly traded on an established 

securities market or the NFFE is a Related Entity of an Entity the 

stock of which is regularly traded on an established securities 

market;

c) The NFFE is organized in a U.S. Territory and all of the owners of 

the payee are bona fide residents of that U.S. Territory;

d) The NFFE is a government (other than the U.S. government), a 

political subdivision of such government (which, for the avoidance 

of doubt, includes a state, province, county, or municipality), or a 

public body performing a function of such government or a 

political subdivision thereof, a government of a U.S. Territory, an 

international organization, a non-U.S. central bank of issue, or an 

Entity wholly owned by one or more of the foregoing; 

e) Substantially all of the activities of the NFFE consist of holding (in 

whole or in part) the outstanding stock of, or providing financing 

and services to, one or more subsidiaries that engage in trades or 

businesses other than the business of a Financial Institution, except 

that an entity shall not qualify for NFFE status if the entity

functions (or holds itself out) as an investment fund, such as a 

private equity fund, venture capital fund, leveraged buyout fund, or 

any investment vehicle whose purpose is to acquire or fund 

companies and then hold interests in those companies as capital 

assets for investment purposes;

f) The NFFE is not yet operating a business and has no prior 

operating history, but is investing capital into assets with the intent 

to operate a business other than that of a Financial Institution,

provided that the NFFE shall not qualify for this exception after the 

date that is 24 months after the date of the initial organization of 

the NFFE;

g) The NFFE was not a Financial Institution in the past five years, and 

is in the process of liquidating its assets or is reorganizing with the 

intent to continue or recommence operations in a business other 

than that of a Financial Institution;

h) The NFFE primarily engages in financing and hedging transactions 

with, or for, Related Entities that are not Financial Institutions, and 

does not provide financing or hedging services to any Entity that is 

not a Related Entity, provided that the group of any such Related 

Entities is primarily engaged in a business other than that of a 

Financial Institution;

i) The NFFE is an “excepted NFFE” as described in relevant U.S. 

Treasury Regulations; or

j) The NFFE meets all of the following requirements:
Model 1 IGA Annex I

November 30, 2014

16

i. It is established and operated in its jurisdiction of residence 

exclusively for religious, charitable, scientific, artistic, 

cultural, athletic, or educational purposes; or it is established 

and operated in its jurisdiction of residence and it is a 

professional organization, business league, chamber of 

commerce, labor organization, agricultural or horticultural 

organization, civic league or an organization operated 

exclusively for the promotion of social welfare;

ii. It is exempt from income tax in its jurisdiction of residence; 

iii. It has no shareholders or members who have a proprietary or 

beneficial interest in its income or assets;

iv. The applicable laws of the NFFE’s jurisdiction of residence 

or the NFFE’s formation documents do not permit any 

income or assets of the NFFE to be distributed to, or applied 

for the benefit of, a private person or non-charitable Entity 

other than pursuant to the conduct of the NFFE’s charitable 

activities, or as payment of reasonable compensation for 

services rendered, or as payment representing the fair market 

value of property which the NFFE has purchased; and

v. The applicable laws of the NFFE’s jurisdiction of residence 

or the NFFE’s formation documents require that, upon the 

NFFE’s liquidation or dissolution, all of its assets be 

distributed to a governmental entity or other non-profit 

organization, or escheat to the government of the NFFE’s 

jurisdiction of residence or any political subdivision thereof.

5. Preexisting Account. A “Preexisting Account” means a Financial 

Account maintained by a [for Model 1A IGAs: Reporting Financial 

Institution][for Model 1B IGAs: Reporting [FATCA Partner] Financial 

Institution] as of the Determination Date.

6. Determination Date. The “Determination Date” means the date, which 

may be prior to entry into force of this Agreement, on which the Treasury 

Department determines not to apply withholding under section 1471 of the 

U.S. Internal Revenue Code to [FATCA Partner] Financial Institutions.

That date is: (a) June 30, 2014, in the case of (i) a jurisdiction that signed 

an agreement with the United States to implement FATCA or facilitate 

FATCA implementation on or before June 30, 2014, or (ii) a jurisdiction 

that the Treasury Department determined reached such an agreement in 

substance on or before June 30, 2014, and is included on the Treasury 

Department list of such jurisdictions, (b) November 30, 2014, in the case 

of a jurisdiction that the Treasury Department determined reached such an 

agreement in substance on or after July 1, 2014, and on or before 

November 30, 2014, and is included on the Treasury Department list of 

such jurisdictions, or (c) the date of signature of such an agreement, in the 

case of any other jurisdiction. The Determination Date for [FATCA 
Model 1 IGA Annex I

November 30, 2014

17

Partner] is [November 30, 2014 or the date of signature of the 

Agreement].1

C. Account Balance Aggregation and Currency Translation Rules.

1. Aggregation of Individual Accounts. For purposes of determining 

the aggregate balance or value of Financial Accounts held by an individual, a 

Reporting [FATCA Partner] Financial Institution is required to aggregate all 

Financial Accounts maintained by the Reporting [FATCA Partner] Financial 

Institution, or by a Related Entity, but only to the extent that the Reporting 

[FATCA Partner] Financial Institution’s computerized systems link the 

Financial Accounts by reference to a data element such as client number or 

taxpayer identification number, and allow account balances or values to be 

aggregated. Each holder of a jointly held Financial Account shall be attributed 

the entire balance or value of the jointly held Financial Account for purposes 

of applying the aggregation requirements described in this paragraph 1.

2. Aggregation of Entity Accounts. For purposes of determining the 

aggregate balance or value of Financial Accounts held by an Entity, a 

Reporting [FATCA Partner] Financial Institution is required to take into 

account all Financial Accounts that are maintained by the Reporting [FATCA

Partner] Financial Institution, or by a Related Entity, but only to the extent that 

the Reporting [FATCA Partner] Financial Institution’s computerized systems 

link the Financial Accounts by reference to a data element such as client 

number or taxpayer identification number, and allow account balances or 

values to be aggregated.

3. Special Aggregation Rule Applicable to Relationship Managers. 

For purposes of determining the aggregate balance or value of Financial 

Accounts held by a person to determine whether a Financial Account is a High 

Value Account, a Reporting [FATCA Partner] Financial Institution is also 

required, in the case of any Financial Accounts that a relationship manager 

knows, or has reason to know, are directly or indirectly owned, controlled, or 

established (other than in a fiduciary capacity) by the same person, to 

aggregate all such accounts.

4. Currency Translation Rule. For purposes of determining the balance 

or value of Financial Accounts denominated in a currency other than the U.S. 

dollar, a Reporting [FATCA Partner] Financial Institution must convert the 

U.S. dollar threshold amounts described in this Annex I into such currency 

using a published spot rate determined as of the last day of the calendar year 

preceding the year in which the Reporting [FATCA Partner] Financial 

Institution is determining the balance or value.

D. Documentary Evidence. For purposes of this Annex I, acceptable 

documentary evidence includes any of the following:

 1 [Either November 30, 2014, or the date of signature, as appropriate as described in (b) or (c), will be included 

in this sentence in the signed Agreement.]
Model 1 IGA Annex I

November 30, 2014

18

1. A certificate of residence issued by an authorized government body 

(for example, a government or agency thereof, or a municipality) of the 

jurisdiction in which the payee claims to be a resident.

2. With respect to an individual, any valid identification issued by an 

authorized government body (for example, a government or agency thereof, or 

a municipality), that includes the individual’s name and is typically used for 

identification purposes.

3. With respect to an Entity, any official documentation issued by an 

authorized government body (for example, a government or agency thereof, or 

a municipality) that includes the name of the Entity and either the address of 

its principal office in the jurisdiction (or U.S. Territory) in which it claims to 

be a resident or the jurisdiction (or U.S. Territory) in which the Entity was 

incorporated or organized.

4. With respect to a Financial Account maintained in a jurisdiction with 

anti-money laundering rules that have been approved by the IRS in connection 

with a QI agreement (as described in relevant U.S. Treasury Regulations), any 

of the documents, other than a Form W-8 or W-9, referenced in the 

jurisdiction’s attachment to the QI agreement for identifying individuals or 

Entities.

5. Any financial statement, third-party credit report, bankruptcy filing, or 

U.S. Securities and Exchange Commission report.

E. Alternative Procedures for Financial Accounts Held by Individual 

Beneficiaries of a Cash Value Insurance Contract. A Reporting [FATCA Partner] 

Financial Institution may presume that an individual beneficiary (other than the 

owner) of a Cash Value Insurance Contract receiving a death benefit is not a Specified 

U.S. Person and may treat such Financial Account as other than a U.S. Reportable 

Account unless the Reporting [FATCA Partner] Financial Institution has actual 

knowledge, or reason to know, that the beneficiary is a Specified U.S. Person. A 

Reporting [FATCA Partner] Financial Institution has reason to know that a 

beneficiary of a Cash Value Insurance Contract is a Specified U.S. Person if the 

information collected by the Reporting [FATCA Partner] Financial Institution and 

associated with the beneficiary contains U.S. indicia as described in subparagraph 

(B)(1) of section II of this Annex I. If a Reporting [FATCA Partner] Financial 

Institution has actual knowledge, or reason to know, that the beneficiary is a Specified 

U.S. Person, the Reporting [FATCA Partner] Financial Institution must follow the 

procedures in subparagraph B(3) of section II of this Annex I.

F. Reliance on Third Parties. Regardless of whether an election is made under 

paragraph C of section I of this Annex I, [FATCA Partner] may permit Reporting 

[FATCA Partner] Financial Institutions to rely on due diligence procedures performed 

by third parties, to the extent provided in relevant U.S. Treasury Regulations.

G. Alternative Procedures for New Accounts Opened Prior to Entry Into 

Force of this Agreement.
Model 1 IGA Annex I

November 30, 2014

19

1. Applicability. If [FATCA Partner] has provided a written notice to 

the United States prior to entry into force of this Agreement that, as of the 

Determination Date, [FATCA Partner] lacked the legal authority to require 

Reporting [FATCA Partner] Financial Institutions either: (i) to require 

Account Holders of New Individual Accounts to provide the self-certification 

specified in section III of this Annex I, or (ii) to perform all the due diligence 

procedures related to New Entity Accounts specified in section V of this 

Annex I, then Reporting [FATCA Partner] Financial Institutions may apply 

the alternative procedures described in subparagraph G(2) of this section, as 

applicable, to such New Accounts, in lieu of the procedures otherwise required 

under this Annex I. The alternative procedures described in subparagraph 

G(2) of this section shall be available only for those New Individual Accounts 

or New Entity Accounts, as applicable, opened prior to the earlier of: (i) the 

date [FATCA Partner] has the ability to compel Reporting [FATCA Partner] 

Financial Institutions to comply with the due diligence procedures described in 

section III or section V of this Annex I, as applicable, which date [FATCA 

Partner] shall inform the United States of in writing by the date of entry into 

force of this Agreement, or (ii) the date of entry into force of this Agreement. 

If the alternative procedures for New Entity Accounts opened after the 

Determination Date, and before January 1, 2015, described in paragraph H of 

this section are applied with respect to all New Entity Accounts or a clearly 

identified group of such accounts, the alternative procedures described in this 

paragraph G may not be applied with respect to such New Entity Accounts. 

For all other New Accounts, Reporting [FATCA Partner] Financial 

Institutions must apply the due diligence procedures described in section III or 

section V of this Annex I, as applicable, to determine if the account is a U.S. 

Reportable Account or an account held by a Nonparticipating Financial 

Institution.

2. Alternative Procedures. 

a) Within one year after the date of entry into force of this 

Agreement, Reporting [FATCA Partner] Financial Institutions must: 

(i) with respect to a New Individual Account described in 

subparagraph G(1) of this section, request the self-certification 

specified in section III of this Annex I and confirm the reasonableness 

of such self-certification consistent with the procedures described in 

section III of this Annex I, and (ii) with respect to a New Entity 

Account described in subparagraph G(1) of this section, perform the 

due diligence procedures specified in section V of this Annex I and 

request information as necessary to document the account, including 

any self-certification, required by section V of this Annex I. 

b) [FATCA Partner] must report on any New Account that is 

identified pursuant to subparagraph G(2)(a) of this section as a U.S. 

Reportable Account or as an account held by a Nonparticipating 

Financial Institution, as applicable, by the date that is the later of: (i) 

September 30 next following the date that the account is identified as a 

U.S. Reportable Account or as an account held by a Nonparticipating 
Model 1 IGA Annex I

November 30, 2014

20

Financial Institution, as applicable, or (ii) 90 days after the account is 

identified as a U.S. Reportable Account or as an account held by a 

Nonparticipating Financial Institution, as applicable. The information 

required to be reported with respect to such a New Account is any 

information that would have been reportable under this Agreement if 

the New Account had been identified as a U.S. Reportable Account or 

as an account held by a Nonparticipating Financial Institution, as 

applicable, as of the date the account was opened.

c) By the date that is one year after the date of entry into force of 

this Agreement, Reporting [FATCA Partner] Financial Institutions 

must close any New Account described in subparagraph G(1) of this 

section for which it was unable to collect the required self-certification 

or other documentation pursuant to the procedures described in 

subparagraph G(2)(a) of this section. In addition, by the date that is 

one year after the date of entry into force of this Agreement, Reporting 

[FATCA Partner] Financial Institutions must: (i) with respect to such 

closed accounts that prior to such closure were New Individual 

Accounts (without regard to whether such accounts were High Value 

Accounts), perform the due diligence procedures specified in 

paragraph D of section II of this Annex I, or (ii) with respect to such 

closed accounts that prior to such closure were New Entity Accounts, 

perform the due diligence procedures specified in section IV of this 

Annex I.

d) [FATCA Partner] must report on any closed account that is 

identified pursuant to subparagraph G(2)(c) of this section as a U.S. 

Reportable Account or as an account held by a Nonparticipating 

Financial Institution, as applicable, by the date that is the later of: (i) 

September 30 next following the date that the account is identified as a 

U.S. Reportable Account or as an account held by a Nonparticipating 

Financial Institution, as applicable, or (ii) 90 days after the account is 

identified as a U.S. Reportable Account or as an account held by a 

Nonparticipating Financial Institution, as applicable. The information 

required to be reported for such a closed account is any information 

that would have been reportable under this Agreement if the account 

had been identified as a U.S. Reportable Account or as an account held 

by a Nonparticipating Financial Institution, as applicable, as of the date 

the account was opened.

H. Alternative Procedures for New Entity Accounts Opened after the 

Determination Date, and before January 1, 2015. For New Entity Accounts 

opened after the Determination Date, and before January 1, 2015, either with respect 

to all New Entity Accounts or, separately, with respect to any clearly identified group 

of such accounts, [FATCA Partner] may permit Reporting [FATCA Partner] 

Financial Institutions to treat such accounts as Preexisting Entity Accounts and apply 

the due diligence procedures related to Preexisting Entity Accounts specified in 

section IV of this Annex I in lieu of the due diligence procedures specified in section 

V of this Annex I. In this case, the due diligence procedures of section IV of this 
Model 1 IGA Annex I

November 30, 2014

21

Annex I must be applied without regard to the account balance or value threshold 

specified in paragraph A of section IV of this Annex I.