Type of Controlling Person. (ONLY to be completed by any individual who is a Controlling Person of an entity investor which is a Passive Non-Financial Entity or an Investment Entity located in a Non-Participating Jurisdiction and managed by another Financial Institution). For joint or multiple Controlling Persons please complete a separate Self-Certification form for each Controlling Person. Please confirm what type of Controlling Person applicable under CRS that applies to you/the investor by ticking the appropriate box. Please tick Entity Name Controlling Person of a legal person – control by ownership ☐ Controlling Person of a legal person – control by other means ☐ Controlling Person of a legal person – senior managing official ☐ Controlling Person of a trust – settlor ☐ Controlling Person of a trust – trustee ☐ Controlling Person of a trust – protector ☐ Controlling Person of a trust – beneficiary ☐ Controlling Person of a trust – other ☐ Controlling Person of a legal arrangement (non-trust) – settlor-equivalent ☐ Controlling Person of a legal arrangement (non-trust) – trustee-equivalent ☐ Controlling Person of a legal arrangement (non-trust) – protector-equivalent ☐ Controlling Person of a legal arrangement (non-trust) – beneficiary-equivalent ☐ Controlling Person of a legal arrangement (non-trust) – other-equivalent ☐
Type of Controlling Person. If the Controlling Person is tax resident in more than three jurisdictions please use a separate sheet Jurisdiction(s) of tax residency Tax reference number type Tax reference number (e.g. TIN) If applicable, please specify the reason for non-availability of a tax reference number: 18 The Controlling Person's TIN is not required to be collected if the Controlling Person is not a Reportable Jurisdiction Person.
Type of Controlling Person. (Please only complete this section if you are tax resident in one or more Reportable Jurisdictions)
Type of Controlling Person. Tick the appropriate box to indicate the type of controlling person for each entity stated in Part 2. Type of Entity Type of Controlling Person Entity (1) Entity (2) Entity (3) Legal Person Individual who has a controlling ownership interest (i.e. not less than 25% of issued share capital) □ □ □ Individual who exercises control/is entitled to exercise control through other means (i.e. not less than 25% of voting rights) □ □ □ Individual who holds the position of senior managing official/ exercises ultimate control over the management of the entity □ □ □ Trust Settlor □ □ □ Trustee □ □ □ Protector □ □ □ Beneficiary or member of the class of beneficiaries □ □ □ Other (e.g. individual who exercises control over another entity being the settlor/trustee/protector/beneficiary) □ □ □ Legal Arrangement Individual in a position equivalent/similar to settlor □ □ □ other than Trust Individual in a position equivalent/similar to trustee □ □ □ Individual in a position equivalent/similar to protector □ □ □ Individual in a position equivalent/similar to beneficiary or member of the class of beneficiaries □ □ □ Other (e.g. individual who exercises control over another entity being equivalent/similar to settlor/trustee/protector/beneficiary) □ □ □
Type of Controlling Person. If the Controlling Person is tax resident in more than three countries please use a separate sheet Country/countries of tax residency Tax reference number type Tax reference number (e.g. TIN) If applicable, please specify the reason for non-availability of a tax reference number:
Type of Controlling Person. (ONLY to be completed by an individual who is a Controlling Person of an entity which is a Passive NFE or an Investment Entity located in a Non-Participating Jurisdiction and managed by another Financial Institution) For Joint or multiple Controlling Person(s) please complete a separate “Individual (Including Controlling Persons) Self-Certification for FATCA and CRS" form for each Controlling Person. Please Confirm the type of Controlling Person applicable under CRS that applies to you/the Account holder by ticking the appropriate box Please Tick Entity Name Controlling Person of a legal person – control by ownership Controlling Person of a legal person – control by other means Controlling Person of a legal person – senior managing official Controlling Person of a trust – settlor Controlling Person of a trust - trustee Controlling Person of a trust – protector Controlling Person of a trust - beneficiary Controlling Person of a trust - other Controlling Person of a legal arrangement (non-trust) – settlor- equivalent Controlling Person of a legal arrangement (non-trust) – trustee- equivalent Controlling Person of protector-equivalent a legal arrangement (non-trust) – Controlling Person of beneficiary-equivalent a legal arrangement (non-trust) – Controlling Person of a legal arrangement (non-trust) – other- equivalent
Type of Controlling Person. If the Controlling Person is tax resident in more than three jurisdictions please use a separate sheet Jurisdiction(s) of tax residency Tax reference number type Tax reference number (e.g. TIN) If applicable, please specify the reason for non-availability of a tax reference number using one of these choices: • Reason 1: The entity will apply or has applied for a tax reference number but has not yet received it • Reason 2: The entity’s jurisdiction of tax residence does not issue tax reference numbers to its residents • Reason 3: Other reason (please specify) 28 The Controlling Person’s TIN is not required to be collected if the Controlling Person is not a Reportable Jurisdiction Person. (Please only complete this section if you are tax resident in one or more Reportable Jurisdictions)
Type of Controlling Person. If the Controlling Person is tax resident in more than three jurisdictions please use a separate sheet. Jurisdiction(s) of tax residency Tax reference number type Tax reference number (e.g. TIN) Jurisdiction(s) of tax residency Tax reference number type Tax reference number (e.g. TIN) Jurisdiction(s) of tax residency Tax reference number type Tax reference number (e.g. TIN) If applicable, please specify the reason for non-availability of a tax reference number: NOT FOR DISTRIBUTION Reason for non-availability of a tax reference number 18The Controlling Person’s TIN is not required to be collected if the Controlling Person is not a Reportable Jurisdiction Person.
Type of Controlling Person. Tick the appropriate box to indicate the type of controlling person for each entity stated in Part 2. Type of Entity Type of Controlling Person Entity (1) Entity (2) Entity (3) Legal Person Individual who has a controlling ownership interest (i.e. not less than 25% of issued share capital) Individual who exercises control/is entitled to exercise control through other means (i.e. not less than 25% of voting rights) Individual who holds the position of senior managing official/ exercises ultimate control over the management of the entity Trust Settlor Trustee Protector Beneficiary or member of the class of beneficiaries Other (e.g. individual who exercises control over another entity being the settlor/trustee/protector/beneficiary) Legal Arrangement other than Trust Individual in a position equivalent/similar to settlor Individual in a position equivalent/similar to trustee Individual in a position equivalent/similar to protector Individual in a position equivalent/similar to beneficiary or member of the class of beneficiaries Other (e.g. individual who exercises control over another entity being equivalent/similar to settlor/trustee/protector/beneficiary) Part 5 Declarations and Signature I acknowledge and agree that (a) the information contained in this form is collected and may be kept by the financial institution 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 the financial institution 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 the account holder 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 / I am authorized to sign for the account holder # of all the account(s) to which this form relates. I undertake to advise Excellent Success Investments Limited of any change in circumstances which affects the tax residency status of the individual identified in Part 1 of this form or causes the information contained herein to become incorrect, and to provide Excellent Success Investments Limited with a suitably updated self-certification form within ...
Type of Controlling Person. If the Controlling Person is tax resident in more than three jurisdictions please use a separate sheet Jurisdiction(s) of tax residency Tax reference number type Tax reference number (e.g. TIN) If applicable, please specify the reason for non-availability of a tax reference number: 12 The Controlling Person’s TIN is not required to be collected if the Controlling Person is not a Reportable Jurisdiction Person. Section 8 – Type of Controlling Person (Please only complete this section if you are tax resident in one or more Reportable Jurisdictions) Please provide the Controlling Person's Status by ticking the appropriate box. Entity 1 Entity 2 Entity 3
