Declarations and Signature. I certify that I am authorised to sign for the Account Holder in respect of all the account(s) to which this form relates. I acknowledge that the information contained in this form and information regarding the Account Holder and any Reportable Account(s) may be provided to the tax authorities of the country/jurisdiction in which this account(s) is/are maintained and exchanged with tax authorities of another country/jurisdiction or countries/jurisdictions in which the Account Holder may be tax resident pursuant to intergovernmental agreements to exchange financial account information. Notwithstanding the Bank’s rights and authorizations under the relevant laws and regulations, if it is proven that the information we have provided to the Bank is incorrect, inaccurate or incomplete, I hereby authorize the Bank to withhold/suspend, or block any amount in our accounts, or close our account, on the grounds that we have failed to fulfil our liabilities. I undertake to advise Xxxxxx Bank A.S. within 90 days of any change in circumstances which affects the tax residency status of the Account Holder identified in this form or causes the information contained herein to become incorrect or incomplete (including any changes to the information on controlling persons identified in 2.3), and to provide Xxxxxx Bank A.S. with a suitably updated self-certification and declaration within 90 days of such change in circumstances.
