Common use of Declarations and Signature Clause in Contracts

Declarations and Signature. I acknowledge and agree that (a) the information contained in this form is collected and may be kept by FSSL/FSFL for the purpose of automatic exchange of financial account information, and (b) such information and information regarding the account holder and any reportable account(s) may be reported by FSSL/FSFL to the Inland Revenue Department of the Government of the Hong Kong Special Administrative Region and exchanged with the tax authorities of another jurisdiction or jurisdictions in which I may be resident for tax purposes, pursuant to the legal provisions for exchange of financial account information provided under the Inland Revenue Ordinance (Cap.112). I certify that I am the Account Holder of all the Account and other account(s) to which this form relates. I undertake to advise FSSL/FSFL of any change in circumstances which affects my tax residency status or causes the information contained herein to become incorrect, and to provide FSSL/FSFL with a suitably updated self-certification form within 30 days of such change in circumstances. I declare that the information given and statements made in this form are true, correct and complete. Signature Name Date(dd/mm/yyyy) 開戶資料表格 附表 4 自我證明表格 –個人 (根據:《稅務條例》（第 112 章）法律條文)) 帳 戶 名 稱 : 帳 戶 號 碼 : 如資料與開户書不同，需填寫第 1 部分 第 1 部 個人帳戶持有人的身分識辨資料 （對於聯名帳戶或多人聯名帳戶，每名個人帳戶持有人須分別填寫一份表格）

Declarations and Signature. I acknowledge and agree that (a) the information contained in this form is collected and may be kept by FSSL/FSFL for the purpose of automatic exchange of financial account information, and (b) such information and information regarding the account holder and any reportable account(s) may be reported by FSSL/FSFL to the Inland Revenue Department of the Government of the Hong Kong Special Administrative Region and exchanged with the tax authorities of another jurisdiction or jurisdictions in which I the Account Holder may be resident for tax purposes, purposes pursuant to the legal provisions for exchange of financial account information provided under the Inland Revenue Ordinance (Cap.112). I certify that I am authorized to sign for the Account Holder of all the Account and other account(s) to which this form relates. I undertake to advise FSSL/FSFL of any change in circumstances which affects my the tax residency status of the Entity Account Holder or causes the information contained herein to become incorrect, and to provide FSSL/FSFL with a suitably updated self-certification form within 30 days of such change in circumstances. I declare that the information given and statements made in this form are true, correct and complete. Signature Name Date(ddCapacity Date (dd/mm/yyyy) (e.g. director or officer of a company, partner of a partnership, trustee of a trust etc.) 開戶資料表格 附表 4 5 自我證明表格 –個人 實體 (根據:《稅務條例》（第 112 章）法律條文)) 帳 戶 名 稱 : 帳 戶 號 碼 : 如資料與開户書不同，需填寫第 1 部分 第 1 部 個人帳戶持有人的身分識辨資料 實體帳戶持有人的身分識辨資料 （對於聯名帳戶或多人聯名帳戶，每名個人帳戶持有人須分別填寫一份表格對於聯名帳戶或多人聯名帳戶，每名實體帳戶持有人須分別填寫一份表格）

Declarations and Signature. I acknowledge and agree that (a) the information contained in this form is collected and may be kept by FSSL/FSFL for the purpose of automatic exchange of financial account information, and (b) such information and information regarding the account holder and any reportable account(s) may be reported by FSSL/FSFL to the Inland Revenue Department of the Government of the Hong Kong Special Administrative Region and exchanged with the tax authorities of another jurisdiction or jurisdictions in which I may be resident for tax purposes, pursuant to the legal provisions for exchange of financial account information provided under the Inland Revenue Ordinance (Cap.112). I certify that I am the Account Holder of all the Account and other account(s) to which this form relates. I undertake to advise FSSL/FSFL of any change in circumstances which affects my tax residency status or causes the information contained herein to become incorrect, and to provide FSSL/FSFL with a suitably updated self-certification form within 30 days of such change in circumstances. I declare that the information given and statements made in this form are true, correct and complete. Signature Name Date(dd/mm/yyyy) 開戶資料表格 附表 4 自我證明表格 –個人 (根據:《稅務條例》（第 112 章）法律條文)) 帳 戶 名 稱 帳戶名稱: 帳 戶 號 碼 帳戶號碼: 如資料與開户書不同，需填寫第 1 部分 第 1 部 個人帳戶持有人的身分識辨資料 （對於聯名帳戶或多人聯名帳戶，每名個人帳戶持有人須分別填寫一份表格）