FATCA Declaration Specified U.S. Person
(a) The Entity is a Specified U.S. Person ☐. The Entity’s U.S. Federal Taxpayer Identifying number (U.S. TIN) is as follows:
FATCA Declaration Specified U.S. Person:
a) The Subscriber is a Specified U.S. Person and the Subscriber’s U.S. Federal Taxpayer Identifying number (U.S. TIN) is as follows: U.S. TIN:
b) The Subscriber is not a Specified U.S. Person (please also complete Sections 3, 4 and 5) Or
