FATCA – CRS ANNEXURE
FOR INDIVIDUALS
Details under FATCA and CRS (see instructions)
(Please consult your professional tax advisor for further guidance on your tax residency, if required)
FOR OFFICE USE ONLY
CUSTOMER ID
SECTION A: Personal Details
PREFIX FIRST NAME MIDDLE NAME/LAST NAME (Please leave one space between words)
City Of Birth Country Of Birth Nationality
Residence Address for Tax Purpose (Tick against one which is applicable)
Same as the address mentioned in Application Form / provided for Bank Record Type of the provided address ( Tick against one which is applicable)
Mailing Address Permanent Address Other (Provide detailed address below) Residential Business Registered Office
If Others provide your Residence Address for Tax Purpose in detail here
CITY
STATE
COUNTRY PIN
SECTION B: Tax Residence Declaration (If Yes, then please fill Section C in detail)
I am a citizen / national / tax resident of any country other than India.
Yes No
SECTION C: Identification Details
PREFIX FATHER’S FIRST NAME FATHER’S MIDDLE NAME/LAST NAME (Please leave one space between words)
Document submitted as proof of identity of the individual ( tick against one which is applicable and provide Identification Number)
DOCUMENT TYPE IDENTIFICATION NUMBER DOCUMENT TYPE IDENTIFICATION NUMBER
Passport Driving License
Voters ID Card Aadhaar Card
PAN Card NREGA Job Card
Govt. ID card Others
Please indicate all the country/countries in which applicant/s is/are resident for tax purposes and the associated Tax ID Number below
Country/(ies) of Tax residency # Tax Identification Number (TIN)% 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 functional equivalent . 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
V1, 04-May-17
SECTION D: Certification, Terms & Conditions and Instructions
I under penalty of perjury, I certify that:
I understand that YES BANK is relying on this information for the purpose of determining the status of the applicant named above in compliance
with FATCA/CRS. YES BANK is not able to offer any tax advice on FATCA or CRS or its impact on me. I have sought/ shall seek advice from
professional tax advisor for any tax questions.
I agree to submit a new form within 30 days if any information or certification on this form becomes incorrect.
I agree that as may be required by domestic regulators/tax authorities, YES BANK may also be required to report, reportable details to CBDT or
other authorities/agencies or close or suspend my account, as appropriate.
I hereby confirm that I have understood the information requirements of this Form (read along with the FATCA/CRS Instructions) and certify that
the information provided by me on this Form including my taxpayer identification number is true, correct, and complete.
I further confirm that I have read and understood the FATCA/CRS Terms and Conditions below and hereby accept the same.
Date: __/ ___/ ____ Place: _________________________ Signature _________________________
FATCA/CRS Terms and Conditions
The Central Board of Direct Taxes has notified Rules 114F to 114H, as part of the Income-tax Rules, 1962, which Rules require Indian financial institutions
such as YES BANK to seek additional personal, tax and beneficial owner information and certain certifications and documentation from all our account
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 account 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 YES BANK or its group entities. Therefore, it
is important that you respond to our request, even if you believe you have already supplied any previously requested information.
FATCA/CRS Instructions
If you have any questions about your tax residency, please contact your tax advisor. If you are a US citizen or resident or green card holder, please
include United States in the foreign country information field along with your US Tax Identification Number.
In case customer has the following Indicia pertaining to a foreign country and yet declares self to be non-tax resident in the respective country, customer to
provide relevant Curing Documents as mentioned below:
FATCA/ CRS Indicia observed Documentation required for Cure of FATCA/ CRS indicia
If customer does not agree to be Specified U.S. person/ reportable person status
U.S. place of birth 1. Self-certification (as specified above) 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 1. Self-certification (as specified above) that the account holder is neither a citizen of United States of America nor a
other than India resident for tax purposes in any other country; and
2. Documentary evidence
Telephone number in a country other 1. Self-certification (as specified above) that the account holder is neither a citizen of United States of America nor a
than India (and no telephone number in resident for tax purposes in any other country; and
India provided) 2. Documentary evidence
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 applicant claims to be a resident.
V1, 04-May-17
