FATCA & CRS ANNEXURE FOR INDIVIDUAL ACCOUNTS

(Including Sole Proprietor) (Refer to instructions)

Please consult your professional tax advisor for further guidance on your tax residency, if required.
1. APPLICANT(S) NAME AND INFORMATION (If the 1st / Sole Applicant is Minor, then please provide details of natural / legal guardian)
1st SOLE APPLICANT Mr. / Ms. / M/s.
Gender Male Female Other PAN Details Occupation Type Service Business Other

Father's Name:

Cust ID / Folio No.1 Cust ID / Folio No.2

Cust ID / Folio No.3 Cust ID / Folio No.4

Address of tax residence would be taken as available in KRA database.
Type of address given at KRA Residential or Business Residential Business Registered Ofce In case of any change please approach KRA & notify the changes

Permissible documents are Passport Election ID Card PAN Card Govt. ID Card Driving License UIDAI Card NREGA Job Card Others

Country of Birth: Nationality: Are you a tax resident of any country 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.

Country# Tax Identication Number% Identication Type

(TIN or Other, please specify)

#To also include USA, where the individual is a citizen / green card holder of The USA
%In case Tax Identication Number is not available, kindly provide its functional equivalent $

2. JOINT APPLICANTS, IF ANY AND THEIR DETAILS

2nd SOLE APPLICANT Mr. / Ms. / M/s.
Gender Male Female Other PAN Details Occupation Type Service Business Other

Father's Name:

Cust ID / Folio No.1 Cust ID / Folio No.2

Cust ID / Folio No.3 Cust ID / Folio No.4

Address of tax residence would be taken as available in KRA database.
Type of address given at KRA Residential or Business Residential Business Registered Ofce In case of any change please approach KRA & notify the changes

Permissible documents are Passport Election ID Card PAN Card Govt. ID Card Driving License UIDAI Card NREGA Job Card Others

Country of Birth: Nationality: Are you a tax resident of any country 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.

Country# Tax Identication Number% Identication Type

(TIN or Other, please specify)

#To also include USA, where the individual is a citizen / green card holder of The USA
%In case Tax Identication Number is not available, kindly provide its functional equivalent $

3. JOINT APPLICANTS, IF ANY AND THEIR DETAILS

3rd SOLE APPLICANT Mr. / Ms. / M/s.
Gender Male Female Other PAN Details Occupation Type Service Business Other

Father's Name:

Cust ID / Folio No.1 Cust ID / Folio No.2

Cust ID / Folio No.3 Cust ID / Folio No.4

Address of tax residence would be taken as available in KRA database.
Type of address given at KRA Residential or Business Residential Business Registered Ofce In case of any change please approach KRA & notify the changes

Permissible documents are Passport Election ID Card PAN Card Govt. ID Card Driving License UIDAI Card NREGA Job Card Others

Country of Birth: Nationality: Are you a tax resident of any country 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.

Country# Tax Identication Number% Identication Type

(TIN or Other, please specify)

#To also include USA, where the individual is a citizen / green card holder of The USA
%In case Tax Identication Number is not available, kindly provide its functional equivalent $
 4. Certication
I / We have understood the information requirements of this Form (read along with the FATCA & CRS Instructions) and hereby conrm that the information provided by me/us on this Form is true, correct, and complete. I /
We also conrm that I / We have read and understood the FATCA & CRS Terms and Conditions below and hereby accept the same.

st
Signature of 1 Applicant / Guardian / Signature of 2nd Applicant / Guardian / Signature of 3rd Applicant / Guardian /
Authorised Signatory /PoA/Karta Authorised Signatory /PoA Authorised Signatory /PoA

Date D D M M Y Y Y Y Place:

FATCA & CRS Terms & Conditions

Details under FATCA & CRS: The Central Board of Direct Taxes has notied Rules 114F to 114H, as part of the Income- tax Rules, 1962, which Rules require Indian nancial institutions such as the Bank to seek additional
personal, tax and benecial owner information and certain certications 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 (Insert FI's name) 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 greencard holder, please include United States in the foreign country information eld along with
your US Tax Identication Number.
$ It is mandatory to supply a TIN or functional equivalent if the country in which you are tax resident issues such identiers. If no TIN is yet available or has not yet been issued, please provide an explanation and attach this
to the form.
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 (ticked) Documentation required for Cure of FATCA/ CRS indicia

U.S. place of birth 1. Self-certication 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:
Certied Copy of “Certicate of Loss of Nationality
or Reasonable explanation of why the customer does not have such a certicate 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-certication 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-certication 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-certication 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)

Telephone number in a country other than India 1. Self-certication 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. Certicate of residence issued by an authorized government body*
2. Valid identication 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.