SUPPLEMENTARY KNOW YOUR CLIENT (KYC), FATCA & CRS -

SELF CERTIFICATION FORM FOR INDIVIDUALS

Mandatory for all Applicant(s) including Joint-holder(s), Guardian (if applicable) and Power of Attorney (if any).
[Please consult your professional tax advisor 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 Registered Office

Nationality Gender Date of birth D D M M Y Y Y Y

Mobile Place of Birth Country of Birth

Father’s name (mandatory if PAN not provided)

Spouse’s name

Documents required (if PAN not provided) Passport Election ID Card Govt. ID Card Driving License UIDAI Card NREGA Card Others

Identification number of the document provided

Is the applicant/ 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.

S No Country of Tax Residency# Tax Payer Identification Number^ Identification Type [TIN or other, please specify]

#To also include USA, where the individual is a citizen/ green card holder 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 Private Sector Public Sector Government Service Student Professional Housewife

Business Retired Agriculture Proprietorship Others _______________________ (please specify)

Gross Annual Income (Rs.) [Please tick (P

)] Below 1 Lac 1 - 5 Lacs 5 - 10 Lacs 10 - 25 Lacs >25 Lacs - 1 Crore >1 Crore

OR

Net-worth (Mandatory for Non-Individuals) Rs.____________________________________________as on (Not older than 1 year)

DD MM YYYY

Politically Exposed Person (PEP) Status* I am PEP I am Related to PEP 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 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 on this Form is true, correct and complete. I hereby agree and confirm to inform HDFC Asset Management Company Limited/HDFC Mutual Fund/ Trustees for any modification to this information promptly.
I 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)'.
I hereby authorize you to disclose, share, remit in any form/manner/mode the above information and/or any part of it including the changes/updates that may be provided by me to the Mutual Fund, its Sponsor/s,
Trustees, Asset Management Company, its employees, agents and third party service providers, SEBI registered intermediaries for single updation/ submission, any Indian or foreign statutory, regulatory, judicial,
quasi- judicial authorities/agencies including but not limited to Financial Intelligence Unit-India (FIU-IND) etc without any intimation/advice to me.

Date: D D M M Y Y Y Y

Place:
First Applicant / Guardian
 Terms and Conditions
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) Documentation required for Cure of FATCA/ CRS indicia

U.S. place of birth 1. 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

Residence/mailing address in a country other than India 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)

Telephone number in a country other than India 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

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)

Standing instructions to transfer funds to an account maintained in a 1. Self-certification that the account holder is neither a citizen of United States of America nor a tax resident of any country other
country other than India (other than depository accounts) 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.