Tax Residency Status - Automatic Exchange of Financial Account Information. Part 1 Entity Type Tick one of the appropriate boxes and provide the relevant information. Financial Institution □ Custodial Institution, Depository Institution or Specified Insurance Company □ Investment Entity, except an investment entity that is managed by another financial institution (e.g. with discretion to manage the entity’s assets) and located in a non-participating jurisdiction Active Non-Financial Entity (“NFE”) □ NFE the stock of which is regularly traded on , which is an established securities market □ Related entity of , the stock of which is regularly traded on , which is an established securities market □ NFE is a governmental entity, an international organization, a central bank, or an entity wholly owned by one or more of the foregoing entities □ Active NFE other than the above (Please specify ) Passive NFE □ Investment entity that is managed by another financial institution and located in a non-participating jurisdiction □ NFE that is not an active NFE Part 2 Controlling Persons (Complete this part if the entity type of the Client is a passive NFE) Indicate the name of all controlling person(s) of the Client in the table below. If no natural person exercises control over an entity which is a legal person, the controlling person will be the individual holding the position of senior managing official. Complete Self-Certification Form – Controlling Person for each controlling person.
