Form 8957

(Rev. October 2015) 

Department of the Treasury 

Internal Revenue Service 

Foreign Account Tax Compliance Act (FATCA) Registration

▶ Information about Form 8957 and its separate instructions is at www.irs.gov/form8957. 

OMB No. 1545-2246

• All applicants must complete Part 1. 

• This form will not be processed if it is not signed. 

• DO NOT fill out this form if you have begun registering at http://www.irs.gov/fatca. 

• The IRS strongly recommends that applicants register by accessing the online version of this form at http://www.irs.gov/fatca. The 

use of this paper form will take longer for the IRS to process and if any information is missing or incomplete the delay in 

registration may be significant. 

• This form should be mailed to: 

FATCA, Stop 6099 AUSC 

3651 South IH 35 

Austin, Texas 78741 

Part 1 Financial Institution Registration 

1 Select Financial Institution Type (check only one)

Single (not a member of an Expanded Affiliated Group)

Lead of an Expanded Affiliated Group

Member (not Lead) of an Expanded Affiliated Group. If a Member, you must provide the FATCA ID issued for such Member and provided 

by your Lead:

Sponsoring Entity 

2 Legal Name of the Financial Institution 

3 a What is the Financial Institution's country/jurisdiction of residence for tax purposes? 

b What is the Financial Institution's country/jurisdiction tax ID?

4 Select the Financial Institution's FATCA classification in its country/jurisdiction of tax residence (check only one) 

Participating Financial Institution not covered by an IGA; or a Reporting Financial Institution under a Model 2 IGA

Registered Deemed-Compliant Financial Institution (including a Reporting Financial Institution under a Model 1 IGA)

Limited Financial Institution

None of the above

5 Mailing Address of Financial Institution

Country/Jurisdiction

Address Line 1

Address Line 2

City State/Province/Region ZIP/Postal Code 

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 37778V Form 8957 (Rev. 10-2015) 
Form 8957 (Rev. 10-2015) Page 2 

6 Indicate whether the Financial Institution has in effect a withholding agreement with the IRS to be treated as one of the following:

a Qualified Intermediary (QI) 

Provide QI EIN: -

Does the Financial Institution intend to maintain its status as a QI?

Yes

No

b Withholding Foreign Partnership (WP) 

Provide WP EIN: -

Does the Financial Institution intend to maintain its status as a WP?

Yes

No

c Withholding Foreign Trust (WT) 

Provide WT EIN: -

Does the Financial Institution intend to maintain its status as a WT? 

Yes

No

d Not applicable

7 Does the Financial Institution maintain a branch in a jurisdiction outside of its country/jurisdiction of tax residence?

Yes (If “Yes,” complete lines 8, 9a, 9b, and 9c)

No (If “No,” go to line 10)

8 Is the Financial Institution a tax resident of the United States or does it maintain a branch in the United States (other than the U.S. territories)? 

Yes Provide the U.S. EIN of the U.S. Financial Institution or U.S. branch: 

 -

No

9a List each jurisdiction (other than the United States) in which the Financial Institution maintains a branch. Also please list branches 

maintained in any of the U.S. territories. If none, leave blank and go to line 10. 

b Is the branch a Limited Branch? 

Yes

No

c If the branch is currently covered by a QI agreement, does the Financial Institution intend to maintain QI status for that branch? 

Yes

No

Not applicable

(Use additional sheets to add branches.)

10 FATCA Responsible Officer (RO) for the Financial Institution

Business Title of RO

Legal Name

Last (Family) First (Given) Middle 

City Country/Jurisdiction

Business Address Line 1

Business Address Line 2 State/Province/Region ZIP/Postal Code

Business Telephone Number Business Fax Number Business Email Address of RO

Form 8957 (Rev. 10-2015) 
Form 8957 (Rev. 10-2015) Page 3

11a The Financial Institution's RO will be a point of contact (POC) for the Financial Institution. In addition, the RO of a Financial Institution 

registering as a Lead of all or part of an Expanded Affiliated Group will be a POC for each Member of that group. 

Does the RO or an Authorizing Individual wish to designate one or more additional POCs for the Financial Institution? 

Yes (If “Yes,” complete line 11b)

No (If “No,” go to line 12)

b This line 11b must be completed by the Financial Institution's RO or an Authorizing Individual. Upon entering the POC information 

below, checking the box that follows, and submitting this registration form, the RO or Authorizing Individual is providing the IRS with 

written authorization to release FATCA information to the POC. This authorization specifically includes authorization for the POC to 

complete this Form 8957: FATCA Registration, to take other FATCA-related actions, and to obtain access to the Financial Institution's 

tax information. 

Business Title of POC

Legal Name of POC

Last (Family) First (Given) Middle 

City Country/Jurisdiction

Business Address Line 1

Business Address Line 2 State/Province/Region ZIP/Postal Code

Business Telephone Number Business Fax Number Business Email Address of POC

Five POCs are allowed per Financial Institution. Use additional sheets to add POCs.

By checking this box, I, , as RO or Authorizing Individual for the Financial Institution, provide the authorization 

described above to the identified POCs listed in this line 11b. Once this authorization is granted, it is effective until revoked by either 

the Financial Institution or the POC.

Part 2 Expanded Affiliated Group

Lead Financial Institutions must read the instructions before completing Part 2.

12 Provide the following for each Financial Institution member of the Expanded Affiliated Group

Legal name of Member Financial Institution Country/Jurisdiction of residence for tax 

purposes Member type *

* Enter one of the following:

Participating Financial Institution not covered by an IGA; or a Reporting Financial Institution under a Model 2 IGA

Registered Deemed-Compliant Financial institution (including a Reporting Financial Institution under a Model 1 IGA)

Limited Financial Institution

Form 8957 (Rev. 10-2015) 
Form 8957 (Rev. 10-2015) Page 4

Part 2 Expanded Affiliated Group (continued)

13a Is the Financial Institution the Common Parent Entity of the Expanded Affiliated Group?

Yes (If “Yes,” go to line 14)

No (If “No,” complete line 13b)

b Enter the Legal Name of the Expanded Affiliated Group’s Common Parent Entity. Also enter the FATCA ID (if known).

Legal Name of the Common Parent Entity ▶

FATCA ID ▶

Part 3 Renewal of Agreement for QIs, WPs, or WTs 

14 Has QI/WP/WT's legal name changed since the effective date of its most recent QI/WP/WT agreement? 

Yes. Provide new legal business name

Provide reason for name change

Merger

Liquidation

Re-branding (name change only)

No

15 Responsible Party

Legal Name of Responsible Party

Last (Family) First (Given) Middle 

Business Title

Business Telephone Number Business Fax Number Business Email Address of Responsible Party

Is the responsible party the same person listed as the RO for the Financial Institution?

Yes

No

16 Identify any private arrangement intermediary (PAI) contracts that are effective: 

Legal Name of PAI

Country/Jurisdiction

Address Line 1

Address Line 2

City State/Province/Region ZIP/ Postal Code 

Email Address of PAI Use additional sheets to add more PAIs.

Part 4 SIGNATURE

By checking this box, I, , certify that, to the best of my knowledge, the information submitted above is accurate and 

complete and I am authorized to agree that the Financial Institution (including its branches, if any) will comply with its FATCA obligations in 

accordance with the terms and conditions reflected in regulations, intergovernmental agreements, and other administrative guidance to the 

extent applicable to the Financial Institution based on its status in each jurisdiction in which it operates.

Sign 

Here 

I declare that I have examined this form including any accompanying statements, and to the best of my knowledge and belief, it is true, correct, and 

complete. 

▲

Signature ▲

Date 

Form 8957 (Rev. 10-2015)