CRS Self-Certification Form – Individuals

This self-certification form is for Individual Account Holders and Sole Traders. Information collected will be used to comply with tax information exchange obligations under FATCA and CRS. Please complete all relevant sections and notify FinClear Services if your circumstances change.

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Part 1 – Identification of Individual Account Holder

A. Name of Account Holder

B. Current Residence Address

Mailing Address (if different)

C. Date of Birth

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Part 2 – Country of Residence for Tax Purposes

Please state the country where you are currently resident for tax purposes.

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Part 3 – Taxpayer Identification Number (TIN)

If you do not provide a TIN, please select the reason below:

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Part 4 – Confirmation of Sole Residency for Tax Purposes

If you are tax resident in one or more additional countries, please complete Part 5 below.

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Part 5 – Additional Countries of Residence for Tax Purposes (if applicable)

If you have additional countries of tax residence, list them below together with your TIN for each country, or indicate if the TIN is unavailable and provide an explanation.

Additional Country 1

Additional Country 2

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Part 6 – Certification and Signature

By submitting this form, you understand that the information supplied is covered by the terms and conditions governing your relationship with FinClear Services and the Privacy Notice in the accompanying documentation. Information on this form and about your account(s) may be reported to relevant tax authorities and exchanged with other tax authorities where required by law. You agree to notify FinClear Services of any change in circumstances that makes any certification on this form incorrect, and to provide an updated form within 30 days of such change. You declare that the information provided is, to the best of your knowledge, true, correct and complete.

If you are not the Account Holder, please indicate the capacity in which you are signing (for example, Power of Attorney). If signing under power of attorney, a certified copy of the power of attorney must be provided.