Final Tax Residency Self-Declaration Form - OCBC

1 No tax obligation( minor, retiree, new citizen)TIN not issued by countryIf TIN is notavailable, selecta reasonTIN not required by countryI am unable to obtain TINprovide reasonCountryTaxpayer Identi cation No. (TIN)CountryTaxpayer Identi cation No. (TIN)No tax obligation( minor, retiree, new citizen)TIN not issued by countryIf TIN is notavailable, selecta reasonTIN not required by countryI am unable to obtain TINprovide :1 93200032W Version dated 21112017 Tax Residency DeclarationAll i nformation is required unless stated. Tax Residency is de ned by each country s local tax laws. This may be dependent on factors including, but not limited to, nationality, physical presence, employment and place of abode.

2 Guidance on tax Residency is also available at the following link: De nition of a Tax Resident:A citizen or permanent resident of the United States ( US Green Card holder or someone who meets the requirements to be considered a resident under the substantial presence test ); or;Any other person that is not a foreign person (as de ned under US federal tax law).2 Your details (declarer)1 NameNRIC / Passport A s per NRI C / Passport Fill up where applicableDate of birth//DD / MM / YYIndicate your country(s) of tax residence12 Country of birthSingaporeTaxpayer Identi cation No. (TIN):United States of America2 Taxpayer Identi cation No. (TIN) / Social Security No. (SSN)If you were born in the but is no longer a tax resident, please provide the following documents:Certi cate of loss of nationality of the I-407 NRICO ther countriesFIN / ASGD / ITRplease tick oneNameNRIC / Passport A s per NRI C / PassportRelationship to customerParent / GrandparentGuardianPOAR esidential addressPostal codeSubmitting this form on behalf of the declarer?

3 Provide your details in this section:Attach a certi ed copy of the power of attorney along withthis :1 93200032W Version dated 21112017 Tax Residency DeclarationAll i nformation is required unless stated. Government issued document may include any documents issued by the local law for the purposes of identi cation and may vary for different may include driving license, employment/residence pass and birth certi declarationI declare that the information provided in this Certi cation form is true, complete and correct to the best of my knowledge and belief. I authorise OCBC Bank to update its records within the information provided by me in this Certi cation form . I also undertake to keep OCBC Bank informed in writing within 30 days of any changes in circumstances that may cause any of the information in this Certi cation form to become incorrect or incomplete and also undertake to provide any other additional information as may be required by OCBC Bank and/or applicable agree that my residential address will be updated if it differs from banking records.

4 This does not include a change to any of my mailing addresses. I agree and consent to the terms of OCBC Bank s (i) Data Protection Policy, (ii) FATCA Policy and (iii) CRS Policy, available at or upon request, which may require the reporting of information supplied by me to relevant tax I am applying for a product from a third party, including without limitation insurance companies and fund houses, I also agree for the information provided in this Certi cation form to be provided by OCBC Bank to the relevant third (As per bank s signi ng record)Country of address outside tax residency3If the country of your residential address differs from the tax Residency declaration , please explain : Tax Residency in Singapore but residential address in MalaysiaThis is one of my many addressesThis is the address of a trusted person ( family member, relative, personal assistant)This is a temporary address ( for studies, work)OthersWhat to do next?

5 65 Please enclose or bring the necessarydocuments as mentioned above. Bring this form to any OCBC branch Mail this form andidenti cation documents back to usSupporting ID and signature veri ed byFor OCBC Bank s use4 Submit these identi cation documents along with this formPlease provide one of the following documents from each of the countries that you are a tax resident of:Passport (with 6 months validity)National identity card (front and back)Government issued identity document3 ( employment pass, driving license)Date of declaration //DD / MM / YYSeal hereSeal hereBUSINESS REPLY SERVIC EPERMIT NO. 01808 Oversea-Chinese Banking Corporation LimitedOCBC BUSINESS CARDROBINSON ROAD B OX 1386 Singapore 902736 GCFS/GCAD August 2012 :193200032 WChange of Address / Contact DetailsPersonal accountAll i nformation is required unless stated.

6 BUSINESS REPLY SERVICEPERMIT NO. 08661 Oversea-Chinese Banking Corporation LtdAccount ServicesLocked Bag Service No. 8 Singapore 911886 Seal the edges with clear tape to secure your documents hereFold herePlease glue within this area. Do not staple or use will be paid by addressee. For posting in Singapore only.