SUPPLEMENTARY KNOW YOUR CLIENT (KYC), FATCA & CRS SELF CERTIFICATION FORM FOR INDIVIDUALS
[Please seek appropriate advice from your professional tax professional on your tax residency and related FATCA & CRS guidance]
A. FATCA & CRS INFORMATION (SELF CERTIFICATION)
PAN
Folio No.
Name
Type of Address given at KRA
Residential
Business
Residential / Business
Nationality
Gender
Mobile
Place of Birth
Registered Office
Date of birth
Country of Birth
(mandatory if PAN not provided)
Fathers name
Spouses name
Passport
Documents required (if PAN not provided)
Election ID Card
Driving License
Govt. ID Card
UIDAI Card
NREGA Card
Others
Identification number of the document provided
Is the applicant(s)/ guardian's Country of Birth / Citizenship / Nationality / Tax Residency other than India?
Yes
No
If yes, please indicate all countries in which you are resident for tax purposes and the associated Tax ID Numbers below.
Identification Type [TIN or other, please specify]
Tax Payer Identification Number^
Country of Tax Residency#
S No
# to include all countries other than India, where investor is Citizen / Resident / Green Card Holder / Tax Resident in those respective countries especially of USA
^In case Tax Identification Number is not available, kindly provide its functional equivalent$
B. ADDITIONAL KYC INFORMATION
Occupation Details [Please tick (P
)]
Service
Business
Gross Annual Income (Rs.) [Please tick (P
)]
Below 1 Lac
Private Sector
Retired
Public Sector
Agriculture
1 - 5 Lacs
Government Service
Professional
Housewife
Others _______________________ (please specify)
Proprietorship
5 - 10 Lacs
Student
10 - 25 Lacs
>25 Lacs - 1 Crore
>1 Crore
OR
Net-worth (Mandatory for Non-Individuals)
Politically Exposed Person (PEP) Status*
Rs.____________________________________________as on
I am PEP
I am Related to PEP
DD
MM
YYYY
(Not older than 1 year)
Not Applicable
*PEP are defined as individuals who are or have been entrusted with prominent public functions in a foreign country, e.g., Heads of States or of Governments, senior politicians, senior Government/judicial/
military officers, senior executives of state owned corporations, important political party officials, etc.
C. Declaration:
I/We have read and understood the information requirements and the Terms and Conditions mentioned in this Form (read alongwith the FATCA & CRS Instructions) and hereby confirm that the information
provided by me/us on this Form is true, correct and complete. I/We hereby agree and confirm to inform HDFC Asset Management Company Limited/HDFC Mutual Fund/ Trustees for any modification to this
information promptly. I/We further agree to abide by the provisions of the Scheme related documents inter alia provisions on 'Foreign Account Tax Compliance Act (FATCA) and Common Reporting Standards
(CRS) on Automatic Exchange of Information (AEOI)'.
Date:
Place:
First Applicant / Guardian
Details under FATCA & CRS
The Central Board of Direct Taxes has notified Rules 114F to 114H, as part of the Income tax Rules, 1962, which require Indian financial institutions to seek additional personal, tax and beneficial owner information
and certain certifications and documentation from all our unit 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 folio(s) or any proceeds in relation thereto.
Should there be any change in any information provided by you, please ensure you advise us promptly, i.e., within 30 days.
Please note that you may receive more than one request for information if you have multiple relationships with us or our group entities. Therefore, it is important that you respond to our request, even if you believe
you have already supplied any previously requested information.
$It is mandatory to supply a TIN or functional equivalent if the country in which you are tax resident issues such identifiers. If no TIN is yet available or has not yet been issued, please provide an explanation and
attach this to the form.
In case investor has the following Indicia pertaining to a foreign country and yet declares self to be non-tax resident in the respective country, investor to provide relevant Curing Documents as mentioned below:
FATCA/ CRS Indicia observed (ticked)
U.S. place of birth
Documentation required for Cure of FATCA/ CRS indicia
1.
Residence/mailing address in a country other than India
Telephone number in a country other than India
Self-certification that the account holder is neither a citizen of United States of America nor a resident for tax purposes;
2.
Non-US passport or any non-US government issued document evidencing nationality or citizenship (refer list below); AND
3.
Any one of the following documents:
a.
Certified Copy of Certificate of Loss of Nationality or
b.
Reasonable explanation of why the customer does not have such a certificate despite renouncing US citizenship; or
Reason the customer did not obtain U.S. citizenship at birth
1.
Self-certification that the account holder is neither a citizen of United States of America nor a tax resident of any country other
than India; and
2.
Documentary evidence (refer list below)
If no Indian telephone number is provided
1.
Self-certification that the account holder is neither a citizen of United States of America nor a tax resident of any country other
than India; and
2.
Documentary evidence (refer list below)
If Indian telephone number is provided along with a foreign country telephone number
Standing instructions to transfer funds to an account maintained in a
country other than India (other than depository accounts)
1.
Self-certification (in attached format) that the account holder is neither a citizen of United States of America nor a tax resident
for tax purposes of any country other than India; OR
2.
Documentary evidence (refer list below)
1.
Self-certification that the account holder is neither a citizen of United States of America nor a tax resident of any country other
than India; and
2.
Documentary evidence (refer list below)
List of acceptable documentary evidence needed to establish the residence(s) for tax purposes:
1.
Certificate of residence issued by an authorized government body*
2.
Valid identification issued by an authorized government body* (e.g. Passport, National Identity card, etc.)
* Government or agency thereof or a municipality of the country or territory in which the payee claims to be a resident.
AMC/ RTA Contact Address & Call Center details
Blank space for Office use only
