FATCA-CRS Declaration Form Individual
BAR CODE
Details under FATCA and CRS
(Please consult your professional tax advisor for further guidance on your tax residency, if required)
Primary Applicant
1) Name*
2) Existing Customer* Y N If Yes, Customer ID
3) Address For Tax Purposes* Communica Permanent Other (If Other, Please fill below)
4) Other Address*
Landmark City
Pin code State Country
5) Address Type* (a) Residential (b) Business Registered Office
6) PAN* OR FORM 60/61*
7) Father’s Name* mandatory if PAN not provided
8) Nationality*
9) City of Birth* (mandatory for for non-resident of India)
10) Country of Birth* (mandatory for for non-resident of India)
11) Identification Type and Identification Number (Documents submitted as per proof of identity of the individual): Name of the document submitted
1
__________________________ Identification number _____________________________________
12 ) Please tick applicable tax resident declaration: (Any one)*
I am a tax resident of India and not resident of any other country
or
I am a tax resident of the country/ies mentioned in the table below
Country* Tax 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 No. is not available, kindly provide functional equivalent$
1
permissible documents are • Passport • Election ID Card • PAN Card • Driving License • UIDAI Card • NREGA Job Card • Others
FATCA-CRS Certification
I have understood the information requitements of this Form (and Terms & Conditions) and hereby confirm that the information provided by me on this Form is true, correct, and
complete and hereby accept the same.
Signature:
Date : ____________________ Place : _________________________
*Mandatory Fields
Joint Applicant 1
1) Name*
2) Existing Customer* Y N If Yes, Customer ID
3) Address For Tax Purposes* Communica Permanent Other (If Other, Please fill below)
4) Other Address*
Landmark City
Pin code State Country
5) Address Type* (a) Residential (b) Business Registered Office
6) PAN* OR FORM 60/61*
7) Father’s Name* mandatory if PAN not provided
8) Nationality*
9) City of Birth* (mandatory for for non-resident of India)
10) Country of Birth* (mandatory for for non-resident of India)
11) Identification Type and Identification Number (Documents submitted as per proof of identity of the individual): Name of the document submitted
1
__________________________ Identification number _____________________________________
12 ) Please tick applicable tax resident declaration: (Any one)*
I am a tax resident of India and not resident of any other country
or
I am a tax resident of the country/ies mentioned in the table below
Country* Tax 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 No. is not available, kindly provide functional equivalent$
1
permissible documents are • Passport • Election ID Card • PAN Card • Driving License • UIDAI Card • NREGA Job Card • Others
FATCA-CRS Certification
I have understood the information requitements of this Form (and Terms & Conditions) and hereby confirm that the information provided by me on this Form is true, correct, and
complete and hereby accept the same.
Signature:
Date : ____________________ Place : _________________________
*Mandatory Fields
Joint Applicant 2
1) Name*
2) Existing Customer* Y N If Yes, Customer ID
3) Address For Tax Purposes* Communica Permanent Other (If Other, Please fill below)
4) Other Address*
Landmark City
Pin code State Country
5) Address Type* (a) Residential (b) Business Registered Office
6) PAN* OR FORM 60/61*
7) Father’s Name* mandatory if PAN not provided
8) Nationality*
9) City of Birth* (mandatory for for non-resident of India)
10) Country of Birth* (mandatory for for non-resident of India)
11) Identification Type and Identification Number (Documents submitted as per proof of identity of the individual): Name of the document submitted
1
__________________________ Identification number _____________________________________
12 ) Please tick applicable tax resident declaration: (Any one)*
I am a tax resident of India and not resident of any other country
or
I am a tax resident of the country/ies mentioned in the table below
Country* Tax 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 No. is not available, kindly provide functional equivalent$
1
permissible documents are • Passport • Election ID Card • PAN Card • Driving License • UIDAI Card • NREGA Job Card • Others
FATCA-CRS Certification
I have understood the information requitements of this Form (and Terms & Conditions) and hereby confirm that the information provided by me on this Form is true, correct, and
complete and hereby accept the same.
Signature:
Date : ____________________ Place : _________________________
*Mandatory Fields
FATCA-CRS Terms and C
The Central Board of Direct Taxes has nitified on 7th August 2015 Rules 114F to 114H, as part of the Income-tax Rules, 1962, which Rules require Indian financial institutions such as the 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 report to tax authorities/ appointed
agencies/ with holding 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
insure you advise us promptly, i.e. within 30 days. 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 field along with your US Tax Identification Number. sIt is mandatory to supply a TIN or functional equivalent if the country in which you are tax resident issue such
identifiers. If no TIN is yet available or has not yet been issued, please provide an explanation and attach this to the form.
