Source: https://nedbankprivatewealth.co.za/content/forms/af/nedbank/CRS-and-FATCA-Entity-Self-Certification.html
Timestamp: 2019-05-20 12:24:58
Document Index: 264584164

Matched Legal Cases: ['art 1', 'art 2', 'art 3', 'art 7', 'art 7', 'art 4', 'art 4', 'art 5', 'art 6', 'art 2', 'art 7', 'art 7', 'art 7', 'art 8']

CRS and FATCA ‒ Entity Self-Certification
Please consult your professional tax advisor with respect to the entity's tax residency and any related guidance on the Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS).
Entity registration number
Name, email address and SA ID or foreign passport number of your controlling person(s) that have foreign tax obligations
Both SA and foreign tax identification number(s) for the entity as applicable
Completing the form takes 10 - 12 minutes.
Glossary of terms for entity self-certification
https://www.nedbank.co.za/content/nedbank/desktop/gt/en/supplimentary/fatca_crs-glossary.html
Part 1 ‒ Identification of entity
Nedbank CIS number
If you have more than one entity with accounts at Nedbank, please complete a self-certification form for each entity.
Entity registration number (if registered)
Country of incorporation or organisation
Part 2 ‒ Certify country of residence for tax purposes
Please select appropriate options that describe the entity:
2.1 Is the entity incorporated or organised or has a place of effective management outside of South Africa (SA)?
2.2 Does the entity have tax obligations, tax liabilities or tax residences outside of South Africa?
2.3 Does any of the controlling persons of the entity:
(a) have tax obligations, tax liabilities or tax residences outside of South Africa, or
(b) hold US citizenship, or are they a US person or a US national?
Please complete a Nedbank Individual and Controlling Person Self-certification form for every controlling person to whom the above applies.
Part 3 ‒ Certify financial institution entity type
Please indicate your entity's type by selecting one of the following options:
3.1 An investment entity that is not resident in a participating jurisdiction and managed by another financial institution?
3.2 Other investment entity?
3.3 A depository institution, custodial institution or specified insurance company?
3.4 A financial institution that meets the definition of a non-participting foreign financial institution (NPFFI)
FATCA - Sponsoring Entity GIIN
Tick here if GIIN captured above belongs to a sponsoring entity
Sponsor's entity name
If 3.4 is selected, Please complete an IRS W-8BEN-E form.
If 3.1 is selected and 2.3 has been answered 'Yes', then complete Part 7 for every controlling person who:
(a) has tax obligations, tax liabilities or tax residencies outside of SA; or
(b) holds US citizenship, or is a US person or a US national?
In addition a Nedbank Individual and Controlling Person Self-certification form must be completed and submitted for each controlling person listed in Part 7 by the relevant controlling person.
Part 4 ‒ Certify United States tax residency
4.1 Is the Entity incorporated or organised in the US?
4.2 Is the entity a trust that a US court would have jurisdiction over or a trust where one or more US person(s) would have the authority to control decisions of the trust?
4.3 Does the entity have any tax obligations in the US?
If any of the options under Part 4 have been selected, please complete IRS W-9 form for the entity.
Part 5 ‒ Entity tax residency
Please complete fields below in relation to the entity, indicating:
5.1 all countries (including US) where the entity is tax resident, has a tax obligation or has a tax liability; and
5.2 the tax payer identification number (TIN) for each country.
Note: If the entity takes the form of a partnership or similar legal arrangement and has no residence for tax purposes, it will be treated as having its tax residence in the jurisdiction in which its place of effective management is situated.
Part 6 - Entity classification
This section applies only for entities that are NOT financial institutions. If 'No' has been selected for all questions under Part 2 (2.1, 2.2 and 2.3), this section does not have to be completed.
The entity must select only ONE of the options below. Part 7 is applicable only if 6.8 is selected.
6.1 Active non-financial entity (NFE) - an entity whose shares are regularly traded on an established stock exchange or an entity that is related to another entity whose shares are regularly traded on an established stock exchange
6.2 Active NFE ‒ a governmental entity
6.3 Active NFE ‒ a central bank
6.4 Active NFE ‒ an international organisation (eg. the European Union, the World Health Organisation or NATO)
6.5 Active NFE ‒ a non-profit entity that is registered as a public benefit organisation (PBO) with the South African Revenue Services (SARS)
6.6 Active NFE ‒ an entity of which less than 50% of the gross income is passive income (such as dividends, interest, royalties, annuities and rent) and less than 50% of the assets held by the entity are assets that produce or are held for the production of passive income.
6.7 Active NFE ‒ an entity other than mentioned in 6.1 to 6.6
6.8 Passive NFE ‒ an entity other than 6.1 to 6.7 above
Entity's shares are traded on an established stock exchange
Abu Dhabi Securities Market (ADSM ) Agricultural Futures Exchange of Thailand (AFET) Alternative Electronic Stock Exchange (AESX) American Stock Exchange (AMEX) Amman Stock Exchange (ASE) Amsterdam Stock Exchange Armenian Stock Exchange (Armex) Asuncion Stock Exchange Athens Stock Exchange (ASE) Australia Pacific Exchange (APX) Australian Securities Exchange (ASX) Bahamas Securities Exchange (BISX) Bahrain Stock Exchange (BSE) Baku Stock Exchange (BSE) Banja Luka Stock Exchange (BLSE) Barbados Stock Exchange (BSE) Barcelona Stock Exchange (Borsa de Barcelona) Beirut Stock Exchange (BSE) Belarusian Currency and Stock Exchange Belgrade Stock Exchange (BELEX) Bendigo Stock Exchange (BSX) Berlin Stock Exchange Bermuda Stock Exchange (BSX) Bern eXchange (BX) BÖAG Börsen Bogota Stock Exchange (BVC) (Bolsa de Valores de Colombia) Bolivian Stock Exchange Bolsa Centroamericana de Valores (BCV) Bolsa de Valores de Cabo Verde (BVC) Bolsa de Valores de El Salvador (BVES) Bolsa de Valores de Guatemala (BNV) Bolsa de Valores de la República Dominicana (BVRD) Bolsa de Valores de Nicaragua (BVDN) Bolsa de Valores de Panama (BVP) Bolsa Mexicana de Valores (BMV) Bolsa Nacional de Valores (BNV) Bolsas y Mercados Españoles (BME) Borsa Italiana Börse Düsseldorf Boston Stock Exchange (BSE) Botswana Stock Exchange (BSE) Bourse de Tunis (BVMT) Bourse Regionale des Valeurs Mobilieres (BRVM) Bratislava Stock Exchange (BSSE) Bucharest Stock Exchange Budapest Stock Exchange (BSE) Buenos Aires Stock Exchange (BCBA) Bulgarian Stock Exchange (BSE) Bursa e Tiranes (Tirana Stock Exchange) Cairo and Alexandria Stock Exchange (CASE) Calcutta Stock Exchange (CSE) Canada's New Stock Exchange (CNQ) Caracas Stock Exchange Casablanca Stock Exchange (CSE) Cayman Islands Stock Exchange (CSX) Channel Islands Channel Islands Stock Exchange Chicago Board of Trade (CBOT) Chicago Board Options Exchange (CBOE) Chicago Mercantile Exchange (CME) Chicago Stock Exchange (CHX) Chile Electronic Stock Exchange (BEC) Chinese Gold and Silver Exchange Society Chittagong Stock Exchange Colombo Stock Exchange (CSE) Copenhagen Stock Exchange (KFX) Cyprus Stock Exchange (CSE) Damascus Securities Exchange (DSE) Dar-es-Salaam Stock Exchange (DSE) Dhaka Stock Exchange (DSE) Doha Securities Market (DSM) Douala Stock Exchange (DSX) Dubai Financial Market (DFM) Dubai International Financial Exchange (DIFX) Eastern Caribbean Securities Exchange (ECSE) EDX London (Equity Derivatives Exchange) Euronext Euronext Amsterdam Euronext Amsterdam (AEX index) Euronext Brussels (BSE) Euronext Lisbon Euronext Paris (CAC 40) Exchange, and Thessaloniki Stock Exchange Center) Faroese Securities Market Frankfurt Stock Exchange Fukuoka Stock Exchange Georgian Stock Exchange (GSX) Ghana Stock Exchange (GSE) Gibraltar Stock Exchange (GibEX) GreTai Securities Market (GTSM) Growth Enterprise Market (GEM) Guayaquil Stock Exchange (BVG, Bolsa de Valores de Guayaquil) Guyana Stock Exchange (GASCI) Haitian Stock Exchange (HSE) Hanoi Securities Trading Center (HASTC) Hellenic Exchanges (HELEX) Helsinki Stock Exchange Ho Chi Minh Stock Exchange (HOSE) Hong Kong Exchanges and Clearing Iceland Stock Exchange (ICEX, Kauphöll Íslands) Indonesia Stock Exchange Inter-connected Stock Exchange (ISE) International Securities Exchange (ISE) Iraq Stock Exchange (ISX) Irish Enterprise Exchange (IEX) Irish Stock Exchange (ISE or ISEQ) Islamabad Stock Exchange (ISE) Istanbul Stock Exchange (ISE) Jamaica Stock Exchange (JSE) JASDAQ Securities Exchange Johannesburg Stock Exchange (JSE) Karachi Stock Exchange (KSE) Kazakhstan Stock Exchange (KASE) Kiev International Stock Exchange Kiev Universal Exchange KLOFFE Automated Trading System (KATS) Korea Exchange (KRX) Kuwait Stock Exchange (KSE) Labuan International Financial Exchange (LFX) Lahore Stock Exchange (LSE) Lima Stock Exchange (BVL, Bolsa de Valores de Lima) Ljubljana Stock Exchange (LJSE) London Metal Exchange (LME) London Stock Exchange Lusaka Stock Exchange (LuSE) Luxembourg Stock Exchange (Bourse de Luxembourg) Macedonian Stock Exchange (Makedonska Berza) Madrid Stock Exchange (Bolsa de Madrid) Malaysia Exchange (MYX, Bursa Malaysia) Maldives Stock Exchange Malta Stock Exchange Market for Alternative Investment (MAI) MEFF (Mercado Oficial Español de Futuros y Opciones) Moldavie Stock Exchange Mongolian Stock Exchange Montenegro Stock Exchange (MNSE) Montevideo Stock Exchange Moscow Interbank Currency Exchange (MICEX) Moscow Stock Exchange (MSE) Multi Commodity Exchange of India (MCX) Muscat Securities Market (MSM) Nagoya Stock Exchange (NSE) Nairobi Stock Exchange (NSE) Namibian Stock Exchange (NSE) Nasdaq Canada NASDAQ Stock Market National Commodity and Derivatives Exchange (NCDEX) National Stock Exchange National Stock Exchange of Australia (NSX) Nepal Stock Exchange (NEPSE) New York Stock Exchange (NYSE) New Zealand Debt Market (NZDX) New Zealand Exchange Limited NewConnect NEX Stock Exchange (NEX) Nigerian Stock Exchange (NSE) NYSE Arca (formerly Pacific Exchange) OMX Exchanges OPEX Osaka Securities Exchange (OSE) Oslo Stock Exchange (OSE) Palestine Securities Exchange (PSE) Pan-European PFTS Ukraine Stock Exchange Philadelphia Stock Exchange Philippine Dealing Exchange (PDEx) Philippine Stock Exchange (PSE) Plus Markets Port Moresby Stock Exchange (POMSoX) Prague Stock Exchange (PSE) Private Placement Exchange (PPDAQ) Pune Stock Exchange (PSE) Quito Stock Exchange (BVQ, Bolsa de Valores de Quito) Riga Stock Exchange (division of the OMX Exchanges) Rio de Janeiro Stock Exchange (BVRJ) RM-Systém Slovakia Russian Trading System (RTS Stock Exchange) Saint Petersburg Stock Exchange (SPBEX) Santiago Stock Exchange (BSE) (Bolsa de Comercio de Santiago) São Paulo Stock Exchange (BMandF Bovespa) Sapporo Stock Exchange Sarajevo Stock Exchange (SASE) Saudi Arabia Electronic Securities Information System Shanghai Stock Exchange (SSE) Shenzhen Stock Exchange SIBEX Singapore Commodity Exchange (SICOM) Singapore Exchange (SGX) South Pacific Stock Exchange (SPSE) Stock Exchange of Thailand (SET) Stockholm Stock Exchange (part of the OMX Exchanges) Stuttgart Stock Exchange (Börse Stuttgart) Swaziland Stock Exchange (SSX) SWX Swiss Exchange Sydney Futures Exchange (SFE) Taiwan Futures Exchange (TAIFEX) Taiwan Stock Exchange (TSEC) Tallinn Stock Exchange (TSE) Tehran Stock Exchange (TSE) Tel-Aviv Stock Exchange (TASE) Thailand Futures Exchange (TFEX) The Bombay Stock Exchange (BSE) The Cochin Stock Exchange Limited (CSE) The Malaysia Derivatives Exchange (MDEX) The National Stock Exchange of India Limited (NSE) Tokyo Stock Exchange (TSE) Toronto Stock Exchange (TSX) Trinidad and Tobago Stock Exchange (TTSE) TSX Venture Exchange US Futures Exchange (USFE) Uganda Securities Exchange Ukrainian Agrarian Mercantile Exchange Ukrainian Interbank Currency Exchange Ukrainian Stock Exchange Valencia Stock Exchange (VSE, Bolsa de Valencia) Valparaíso Stock Exchange (BOVALPO) Vilnius Stock Exchange Vinnitsa Commodity Exchange Warsaw Stock Exchange (WSE) Wiener Börse – Vienna Stock Exchange (WBAG) Winnipeg Stock Exchange (WCE) Zagreb Stock Exchange (ZSE) Zimbabwe Stock Exchange (ZSE)
Entity is related to another entity whose shares are regularly traded on established stock exchange
PBO number issued by SARS
If 6.8 is selected and 2.3 has been answered 'Yes', then complete Part 7 for every controlling person who:
Part 7 ‒ Controlling person identification
SA ID Passport Foreign ID
Part 8 ‒ Declaration and acceptance of terms and conditions
(i) am authorised to sign this document on behalf of the entity and declare that all statements made in this declaration are, to the best of my knowledge and belief, correct and complete;
(ii) undertake to advise Nedbank within 30 days of any circumstances that affects the entity's tax residency status or causes the information contained herein to become incorrect, including any changes to the information on controlling persons of the entity, and to provide Nedbank with updated self-certification forms within 90 days of such change in circumstances;
(iii) understand that the information contained in this form and the information regarding any portable accounts may be provided to SARS, and exchanged with tax authorities of another/other country/countries in which the entity or any controlling persons may be a tax resident(s) in terms of South African tax legislation; and
(iv) understand that, by selecting 'Yes' below, it is deemed that I, the duly authorised representative of the entity, have attached my signature to this document.
Name of the duly authorised representative of the entity
Please indicate if you are signing in your capacity as any one of the following:
Authorised director of the company Authorised officer of the entity Chief Executive Officer Chief Financial Officer Chief Operations Officer Company Secretary Managing Director Member of a close corporation Partner of a partnership Power of attorney Trustee of a trust