Contract
遵循防制洗錢及打擊資助恐怖主義聲明暨同意書（個人適用）
姓名 （需與證件全名相同） | （若身分證件有英文姓名，請您一併填寫） | 國籍 | (若有多國籍時，請您一併填寫) |
身分證件號碼 | 身分證件類型 | □身分證□護照□居留證□其他 |
本人聲明願配合貴公司遵循「洗錢防制法」、「資恐防制法」、「金融機構防制洗錢辦法」、「證券期貨業及其他經金融監督管理委員會指定之金融機構防制洗錢及打擊資恐內部控制與稽核制度實施辦法」、「個人資料保護法」等相關規定，同意遵照貴公司下列約定事項及同意貴公司得蒐集
、處理及利用本聲明書所載之姓名、證照號碼等資料，並如實出具以下之聲明。
一、約定事項
1. 本人如為受經濟制裁、外國政府或國際洗錢防制組織認定或追查之恐怖分子或團體者，貴公司得直接拒絕業務往來，逕行關戶。
2. 本人如有聲明不實、不配合定期審視，對交易之性質與目的或資金來源不願配合說明者，貴公司得暫時停止交易，或終止業務關係。
二、聲明事項
1.主要資金／財產來源（可複選）
□薪資／營利收入 | □退休金 | □不動產買賣 |
□利息／租金收入 | □貸款 | □投資收益／保險／基金／股票 |
□遺產所得／贈與 | □交易所得 | □銀行存款，存款來源： |
□其他： | ||
2.職業類別代號：□□□□（請詳附表）工作說明：
任職機構全名：
主要工作地：□國內＿ （縣市）□國外 （國別）
此致 日盛期貨股份有限公司暨其期貨交易輔助人
立聲明書人：
（簽名/簽名及xx）
法定代理人1： 法定代理人1國籍／證照號碼：
（簽名/簽名及xx）
法定代理人2： 法定代理人2國籍／證照號碼：
（簽名/簽名及xx）
日期：西元 年 月 日
覆核： 經辦：
108.06 月版
【附表】
代號 | 職業類別 | 代號 | 職業類別 | 代號 | 職業類別 | 代號 | 職業類別 |
10 | 政府機構 | 1000 | 金融業 | 2000 | 專業技術人員 | 3000 | 學術/文化/教育機構 |
1 | 公務人員 | 1101 | 銀行/農漁/金融/保險 | 2201 | 律師 | 3301 | 教育機構/教師 |
2 | 警察/消防/軍人 | 1103 | 證券/期貨/投顧/投信 | 2202 | 地政士 | 3302 | 公益/社團/基金會 |
3 | 軍政單位採購人員 | 1199 | 金融業-其他 | 2210 | 醫生 | 3399 | 學術/文化/教育-其他 |
4 | 政治人物 | 2211 | 會計師 | ||||
99 | 政府機構-其他 | 2212 | 建築師 | ||||
2213 | 副教授以上 | ||||||
2299 | 專業技術人員-其他 | ||||||
4000 | 製造/營造業 | 5000 | 服務業 | 6000 | 旅遊/運輸業 | 7000 | 銷售業 |
4401 | 電子/科技產業 | 5501 | 醫院/醫療(服) | 6601 | 旅遊 | 7701 | 大型連鎖之銷售業 |
4402 | 食品/藥粧/日常用品 | 5504 | 環保/空調/通信/電子 | 6602 | 運輸 | 7702 | 小型零售業 |
4499 | 製造/營造業-其他 | 5505 | 律師事務所 | 6699 | 旅遊/運輸業-其他 | 7703 | 黃金、珠寶商 |
5506 | 會計師事務所 | 7704 | 軍火販賣 | ||||
5507 | 建築師事務所 | 7710 | 推銷業-直銷/信用卡 | ||||
5599 | 服務業-其他 | 7799 | 銷售業-其他 | ||||
8000 | 餐飲/娛樂 | 9000 | 其他 | ||||
8801 | 餐飲店 | 9901 | 家管 | ||||
8802 | 遊樂園 | 9902 | 學生 | ||||
8804 | 美容(髮)/婚紗/健身房 | 9903 | 無業 | ||||
8805 | 視聽歌唱業 | 9904 | 自由業 | ||||
8806 | 舞廳業 | 9905 | 退休 | ||||
8807 | 三溫暖業 | 9906 | 文字工作者 | ||||
8808 | 舞場業 | 9907 | 農林養漁牧業 | ||||
8809 | 酒家業 | 9908 | 宗教相關行業 | ||||
8810 | 酒吧業 | 9909 | 其他未歸類之行業 | ||||
8812 | 特種咖啡茶室業 | 9912 | 銀樓 | ||||
8813 | 賭博業 | 9913 | 當鋪 | ||||
8814 | 電玩 | 9914 | 房地產 | ||||
8815 | 夜總會 | 9915 | 藝術 | ||||
8899 | 餐飲/娛樂-其他 |
108.06 月版
FATCA暨CRS身分別辨識聲明書 （個人戶使用）
為因應美國海外帳戶稅收遵從法（FATCA）及我國金融機構執行共同申報及盡職審查作業辦法(CRS)，立聲明書人特此聲明如下，並同意 貴公司得於符合中華民國法律之前提下，若立聲明書人為美國稅務居住者， 貴公司將依美國稅務機關之要求，將其相關資訊申報予美國稅務機關；若立聲明書人屬CRS應申報國家稅務居住者， 貴公司將依我國稅捐稽徵機關之要求，將其相關資訊申報予我國稅捐稽徵機關，經由政府間協定進行稅務目的金融帳戶資訊交換，提供予立聲明書人為稅務居住者之國家/地區的稅捐稽徵機關。
一、 基本資訊及聲明事項(*為必填欄位；若具有美國或其他國家或地區稅務居住者身分，必填欄位除中文姓名外請全部以英文填寫，並需填寫**欄位。):
1. | 中文姓名* | ||||||||||
英文姓名** | First Given name | or | Middle name(s) | Last name or surname(s) | |||||||
現行居住地址* | (室、樓層、大樓、街道、地 | ||||||||||
⬜與戶籍地址相 | 區等) | ||||||||||
同 | |||||||||||
若無戶籍地址，請另填身分證明文據上之地址: ⬜身分證 | 地址 | 國 家或 地區 | 郵 遞區號 | ||||||||
(鎮、市、省、縣、州等) | |||||||||||
⬜護照 | |||||||||||
2 | ⬜居留證 | ||||||||||
⬜ 其 他 證 明 文 據 | |||||||||||
(室、樓層、大樓、街道、地 | |||||||||||
通訊地址 ⬜與現行居住地址相同 | 地址 | 區等) | 國 家或 地區 | 郵遞區號 | |||||||
(鎮、市、省、縣、州等) | |||||||||||
3 | 出生日期* | 西元 | 年 | 月 | 日 | ||||||
4 | 出生地** | 國家或地區: | 城市: | ||||||||
本人具有以下居住國家或地區之稅務居住者身分或指標*【本人如同時為2個以上國家或地區稅務居住者，請勾選所有適用之居住國家或地區，得複選】:
A. □本人具有中華民國稅務居住者身分。若勾選此項，請提供身分證字號等編號
。
填列說明如下：
1. 具身分證字號者為身分證字號(10碼，由內政部戶政司編配)。
2. 具統一證號者為統一證號(10碼，由內政部移民署編配)。
3. 個人無身分證字號或統一證號者，以現行稅籍編號(大陸地區人民為9＋西元出生年後2碼及出生月日4碼；其餘情形為西元出生年月日8碼＋護照顯示英文姓名前2字母2碼)方式編配。
108.01 月版
B. □本人具有美國公民或稅務居住者身分（並提供 IRS Form W-9 及「FATCA 個人資料同意聲明書」）。
C. □本人具有以下外國指標，但不是外國稅務居住者。
指標 | 美國 (請填寫 Form W-8BEN) | 其他國家或地區 (請註明) |
1. 具有外國公民身分或居留權 (例如綠卡)或稅務居住者身分 | □ | □ |
2. 美國出生地 【請提供喪失美國國籍證明或其他合理書面解釋】 | □ | |
3. 留存戶籍、現行居住地址或通訊地址為外國住址(含郵政信箱) | □ | □ |
4. 具外國電話號碼，且無我國電話號碼 | □ | □ |
5. 約定轉帳指示匯款到外國帳戶 | □ | □ |
6. 被授權人或被授權簽名人具外國之地址 | □ | □ |
7. 僅具外國之轉信地址或代收郵寄地址 | □ | □ |
D. □本人具有其他國家或地區稅務居住者身分。
(i) 居住國家或地區 | (ii) 是否有居住國家或地區之稅籍編號 | ||
是 (請提供稅籍編號) | 否 (請填寫理由A、B或C，理由B須說明無法取得稅籍編號的原因) | ||
1 | |||
2 | |||
3 | |||
【若勾選此項，請完成以下表格並列出本人除中華民國(ROC)或美國以外之所有(i)稅務居住國家或地區及(ii)稅務居住國家或地區之稅籍編號。若立約人之居住國家或地區超過三個，請填寫於另外的表格】
理由 A - 本人之居住國家或地區未核發稅籍編號予其居住者。
理由 B - 本人無法取得稅籍編號或具相當功能之識別碼(若選取此理由，請解釋無法取得稅籍編號的原因)。
理由 C - 無須蒐集稅務編號。(註: 選取此理由限其國內法未要求蒐集稅籍編號資訊)。
註：美國公民或稅務居住者係指具有美國國籍者(持有美國護照)、持有綠卡者，或當年度入境美國並停留超過 183 天，或者當年度入境並在美國待超過 31 天，同時滿足所謂的『前 3 年審核期』的計算超過 183 天。(『前 3 年審核期』係以報稅年度及前二年在美居留天數「加權」計算，當年度在美國實際居留天數×１＋前一年度在美國實際居留天數×1/3＋前二年度在美國實際居留天數×1/6，若總天數大於或等於 183 天，該客戶即為美國稅務居住者)
108.01 月版
二、聲明及簽署：
本人知悉，本聲明書所含資訊、相關帳戶持有人及任何應申報帳戶資訊，將可能申報予美國稅務機關及中華民國稅捐稽徵機關，經由政府間協定進行稅務目的金融帳戶資訊交換，提供予帳戶持有人為稅務居住者之國家/地區的稅捐稽徵機關。
本人證明，與本聲明書相關之所有帳戶，本人為帳戶持有人。
本人聲明，就本人所知所信，於本聲明書所為之xx均為正確且完整。
上述內容均屬事實，本人同意應依日盛期貨之請求提供必要相關文件以佐證，如有不實願負一切法律責任，且若日後遇有情況變更情形應於 30 天內主動告知日盛期貨。提供日盛期貨一份經適當更新之FATCA 聲明書暨 CRS 身分別辨識聲明書。本人了解並同意日盛期貨有權合理認定上開聲明內容之真偽或變更情形而對本人帳戶權利為必要的處置行為，包含但不限於辦理美國稅扣繳或終止帳戶服務。
此致 日盛期貨股份有限公司暨其期貨交易輔助人
立 書 人：
（親簽）
中華民國 年 月 日
主管： 建檔： 經辦:
108.01 月版
Form W-9 (Rev. October 2018) Department of the Treasury Internal Revenue Service
Request for Taxpayer Identification Number and Certification
▶ Go to xxx.xxx.xxx/XxxxX0 for instructions and the latest information.
Give Form to the requester. Do not send to the IRS.
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
2 Business name/disregarded entity name, if different from above
Print or type.
See Specific Instructions on page 3.
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes.
4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):
Individual/sole proprietor or single-member LLC
C Corporation
S Corporation
Partnership
Trust/estate
Exempt payee code (if any)
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ▶
Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner.
Other (see instructions) ▶
Exemption from FATCA reporting code (if any)
(Applies to accounts maintained outside the U.S.)
5 Address (number, street, and apt. or suite no.) See instructions. Requester’s name and address (optional)
6 City, state, and ZIP code
7 List account number(s) here (optional)
Part I Taxpayer Identification Number (TIN)
Employer identification number | |||||||||||
– | |||||||||||
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later.
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter.
Social security number
– –
or
Part II Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Sign Here
Signature of
U.S. person ▶
Date ▶
General Instructions
Section references are to the Internal Revenue Code unless otherwise noted.
Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to xxx.xxx.xxx/XxxxX0.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
• Form 1099-DIV (dividends, including those from stocks or mutual funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)
• Form 1099-B (stock or mutual fund sales and certain other transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later.
Cat. No. 10231X Form W-9 (Rev. 10-2018)
By signing the filled-out form, you:
1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and
4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting, later, for further information.
Note: If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien;
• A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States;
• An estate (other than a foreign estate); or
• A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners’ share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your
U.S. status and avoid section 1446 withholding on your share of partnership income.
In the cases below, the following person must give Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States.
• In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the entity;
• In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the trust; and
• In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries of the trust.
Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities).
Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a “saving clause.” Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items.
1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions.
4. The type and amount of income that qualifies for the exemption from tax.
5. Sufficient facts to justify the exemption from tax under the terms of the treaty article.
Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form
W-9 a statement that includes the information described above to support that exemption.
If you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form W-8 or Form 8233.
Backup Withholding
What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 24% of such payments. This is called “backup withholding.” Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made in settlement of payment card and third party network transactions, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding.
You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the instructions for Part II for details),
3. The IRS tells the requester that you furnished an incorrect TIN,
4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or
5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only).
Certain payees and payments are exempt from backup withholding. See Exempt payee code, later, and the separate Instructions for the Requester of Form W-9 for more information.
Also see Special rules for partnerships, earlier.
What is FATCA Reporting?
The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specified United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code, later, and the Instructions for the Requester of Form
W-9 for more information.
Updating Your Information
You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account; for example, if the grantor of a grantor trust dies.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty.
Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.
Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties.
Specific Instructions
Line 1
You must enter one of the following on this line; do not leave this line blank. The name should match the name on your tax return.
If this Form W-9 is for a joint account (other than an account maintained by a foreign financial institution (FFI)), list first, and then circle, the name of the person or entity whose number you entered in Part I of Form W-9. If you are providing Form W-9 to an FFI to document a joint account, each holder of the account that is a U.S. person must provide a Form W-9.
a. Individual. Generally, enter the name shown on your tax return. If you have changed your last name without informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name.
Note: ITIN applicant: Enter your individual name as it was entered on your Form W-7 application, line 1a. This should also be the same as the name you entered on the Form 1040/1040A/1040EZ you filed with your application.
b. Sole proprietor or single-member LLC. Enter your individual name as shown on your 1040/1040A/1040EZ on line 1. You may enter your business, trade, or “doing business as” (DBA) name on line 2.
c. Partnership, LLC that is not a single-member LLC, C corporation, or S corporation. Enter the entity's name as shown on the entity's tax return on line 1 and any business, trade, or DBA name on line 2.
d. Other entities. Enter your name as shown on required U.S. federal tax documents on line 1. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on line 2.
e. Disregarded entity. For U.S. federal tax purposes, an entity that is disregarded as an entity separate from its owner is treated as a “disregarded entity.” See Regulations section 301.7701-2(c)(2)(iii). Enter the owner's name on line 1. The name of the entity entered on line 1 should never be a disregarded entity. The name on line 1 should be the name shown on the income tax return on which the income should be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a single owner that is a U.S. person, the U.S. owner's name is required to be provided on line 1. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on line 2, “Business name/disregarded entity name.” If the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W-8 instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN.
Line 2
If you have a business name, trade name, DBA name, or disregarded entity name, you may enter it on line 2.
Line 3
Check the appropriate box on line 3 for the U.S. federal tax classification of the person whose name is entered on line 1. Check only one box on line 3.
IF the entity/person on line 1 is a(n) . . . | THEN check the box for . . . |
• Corporation | Corporation |
• Individual • Sole proprietorship, or • Single-member limited liability company (LLC) owned by an individual and disregarded for U.S. federal tax purposes. | Individual/sole proprietor or single- member LLC |
• LLC treated as a partnership for U.S. federal tax purposes, • LLC that has filed Form 8832 or 2553 to be taxed as a corporation, or • LLC that is disregarded as an entity separate from its owner but the owner is another LLC that is not disregarded for U.S. federal tax purposes. | Limited liability company and enter the appropriate tax classification. (P= Partnership; C= C corporation; or S= S corporation) |
• Partnership | Partnership |
• Trust/estate | Trust/estate |
Line 4, Exemptions
If you are exempt from backup withholding and/or FATCA reporting, enter in the appropriate space on line 4 any code(s) that may apply to you.
Exempt payee code.
• Generally, individuals (including sole proprietors) are not exempt from backup withholding.
• Except as provided below, corporations are exempt from backup withholding for certain payments, including interest and dividends.
• Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions.
• Corporations are not exempt from backup withholding with respect to attorneys’ fees or gross proceeds paid to attorneys, and corporations that provide medical or health care services are not exempt with respect to payments reportable on Form 1099-MISC.
The following codes identify payees that are exempt from backup withholding. Enter the appropriate code in the space in line 4.
1—An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2)
2—The United States or any of its agencies or instrumentalities 3—A state, the District of Columbia, a U.S. commonwealth or
possession, or any of their political subdivisions or instrumentalities
4—A foreign government or any of its political subdivisions, agencies, or instrumentalities
5—A corporation
6—A dealer in securities or commodities required to register in the United States, the District of Columbia, or a U.S. commonwealth or possession
7—A futures commission merchant registered with the Commodity Futures Trading Commission
8—A real estate investment trust
9—An entity registered at all times during the tax year under the Investment Company Act of 1940
10—A common trust fund operated by a bank under section 584(a) 11—A financial institution
12—A middleman known in the investment community as a nominee or custodian
13—A trust exempt from tax under section 664 or described in section 4947
The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 13.
IF the payment is for . . . | THEN the payment is exempt for . . . |
Interest and dividend payments | All exempt payees except for 7 |
Broker transactions | Exempt payees 1 through 4 and 6 through 11 and all C corporations. S corporations must not enter an exempt payee code because they are exempt only for sales of noncovered securities acquired prior to 2012. |
Xxxxxx exchange transactions and patronage dividends | Exempt payees 1 through 4 |
Payments over $600 required to be reported and direct sales over $5,0001 | Generally, exempt payees 1 through 52 |
Payments made in settlement of payment card or third party network transactions | Exempt payees 1 through 4 |
1 See Form 1099-MISC, Miscellaneous Income, and its instructions.
2 However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup
withholding: medical and health care payments, attorneys’ fees, xxxxx proceeds paid to an attorney reportable under section 6045(f), and payments for services paid by a federal executive agency.
Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form if you are uncertain if the financial institution is subject to these requirements. A requester may indicate that a code is not required by providing you with a Form W-9 with “Not Applicable” (or any similar indication) written or printed on the line for a FATCA exemption code.
A—An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701(a)(37)
B—The United States or any of its agencies or instrumentalities C—A state, the District of Columbia, a U.S. commonwealth or
possession, or any of their political subdivisions or instrumentalities
D—A corporation the stock of which is regularly traded on one or more established securities markets, as described in Regulations section 1.1472-1(c)(1)(i)
E—A corporation that is a member of the same expanded affiliated group as a corporation described in Regulations section 1.1472-1(c)(1)(i)
F—A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any state
G—A real estate investment trust
H—A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940
I—A common trust fund as defined in section 584(a) J—A bank as defined in section 581
K—A broker
L—A trust exempt from tax under section 664 or described in section 4947(a)(1)
M—A tax exempt trust under a section 403(b) plan or section 457(g) plan
Note: You may wish to consult with the financial institution requesting this form to determine whether the FATCA code and/or exempt payee code should be completed.
Line 5
Enter your address (number, street, and apartment or suite number). This is where the requester of this Form W-9 will mail your information returns. If this address differs from the one the requester already has on file, write NEW at the top. If a new address is provided, there is still a chance the old address will be used until the payor changes your address in their records.
Line 6
Enter your city, state, and ZIP code.
Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN below.
If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN.
If you are a single-member LLC that is disregarded as an entity separate from its owner, enter the owner’s SSN (or EIN, if the owner has one). Do not enter the disregarded entity’s EIN. If the LLC is classified as a corporation or partnership, enter the entity’s EIN.
Note: See What Name and Number To Give the Requester, later, for further clarification of name and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local SSA office or get this form online at xxx.XXX.xxx. You may also get this form by calling 0-000-000-0000. Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at xxx.xxx.xxx/Xxxxxxxxxx and clicking on Employer Identification Number (EIN) under Starting a Business. Go to xxx.xxx.xxx/Xxxxx to view, download, or print Form W-7 and/or Form SS-4. Or, you can go to xxx.xxx.xxx/XxxxxXxxxx to place an order and have Form W-7 and/or SS-4 mailed to you within 10 business days.
If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and write “Applied For” in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester.
Note: Entering “Applied For” means that you have already applied for a TIN or that you intend to apply for one soon.
Caution: A disregarded U.S. entity that has a foreign owner must use the appropriate Form W-8.
Part II. Certification
To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if item 1, 4, or 5 below indicates otherwise.
For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on line 1 must sign. Exempt payees, see Exempt payee code, earlier.
Signature requirements. Complete the certification as indicated in items 1 through 5 below.
1. Interest, dividend, and xxxxxx exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification.
2. Interest, dividend, broker, and xxxxxx exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form.
3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification.
4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. “Other payments” include payments made in the course of the requester’s trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments made in settlement of payment card and third party network transactions, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations).
5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), ABLE accounts (under section 529A), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification.
For this type of account: | Give name and SSN of: |
1. Individual | The individual |
2. Two or more individuals (joint account) other than an account maintained by an FFI | The actual owner of the account or, if combined funds, the first individual on the account1 |
3. Two or more U.S. persons (joint account maintained by an FFI) | Each holder of the account |
4. Custodial account of a minor (Uniform Gift to Minors Act) | The minor2 |
5. a. The usual revocable savings trust (grantor is also trustee) b. So-called trust account that is not a legal or valid trust under state law | The grantor-trustee1 The actual owner1 |
6. Sole proprietorship or disregarded entity owned by an individual | The owner3 |
7. Grantor trust filing under Optional Form 1099 Filing Method 1 (see Regulations section 1.671-4(b)(2)(i) (A)) | The grantor* |
For this type of account: | Give name and EIN of: |
8. Disregarded entity not owned by an individual | The owner |
9. A valid trust, estate, or pension trust | Legal entity4 |
10. Corporation or LLC electing corporate status on Form 8832 or Form 2553 | The corporation |
11. Association, club, religious, charitable, educational, or other tax- exempt organization | The organization |
12. Partnership or multi-member LLC | The partnership |
13. A broker or registered nominee | The broker or nominee |
What Name and Number To Give the Requester
For this type of account: | Give name and EIN of: |
14. Account with the Department of Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments | The public entity |
15. Grantor trust filing under the Form 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulations section 1.671-4(b)(2)(i)(B)) | The trust |
1 List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person’s number must be furnished.
2 Circle the minor’s name and furnish the minor’s SSN.
3 You must show your individual name and you may also enter your business or DBA name on the “Business name/disregarded entity” name line. You may use either your SSN or EIN (if you have one), but the IRS encourages you to use your SSN.
4 List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Also see Special rules for partnerships, earlier.
*Note: The grantor also must provide a Form W-9 to trustee of trust.
Note: If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed.
Secure Your Tax Records From Identity Theft
Identity theft occurs when someone uses your personal information such as your name, SSN, or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund.
To reduce your risk:
• Protect your SSN,
• Ensure your employer is protecting your SSN, and
• Be careful when choosing a tax preparer.
If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter.
If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 0-000-000-0000 or submit Form 14039.
For more information, see Pub. 5027, Identity Theft Information for Taxpayers.
Victims of identity theft who are experiencing economic harm or a systemic problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll-free case intake line at 0-000-000-0000 or TTY/TDD 0-000-000-0000.
Protect yourself from suspicious emails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft.
The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts.
If you receive an unsolicited email claiming to be from the IRS, forward this message to xxxxxxxx@xxx.xxx. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration (TIGTA) at 0-000-000-0000. You can forward suspicious emails to the Federal Trade Commission at xxxx@xxx.xxx or report them at xxx.xxx.xxx/xxxxxxxxx. You can contact the FTC at xxx.xxx.xxx/xxxxxxx or 877-IDTHEFT (877-438-4338). If you have been the victim of identity theft, see xxx.XxxxxxxxXxxxx.xxx and Pub. 5027.
Visit xxx.xxx.xxx/XxxxxxxxXxxxx to learn more about identity theft and how to reduce your risk.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information.
Xxxxxxx uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information.
F-I1
日盛期貨股份有限公司個人資料同意書
緣本人為 貴公司之客戶，已受 貴公司依個人資料保護法相關規定明確告知（一）非公務機關名稱、（二）蒐集之目的、（三）個人資料之類別、（四）個人資料利用之期間、地區、對象及方式、（五）當事人依個人資料保護法第三條規定得行使之權利及方式（六）當事人得自由選擇提供個人資料時，不提供將對其權益之影響等事項。
今因 貴公司遵循美國海外帳戶稅收遵從法案（Foreign Account Tax Compliance Act，下簡稱
「FATCA 法案」）及外國金融機構協議（FFI Agreement，下簡稱「協議」）相關規定之需要，本人同意，除已受 貴公司所告知特定目的之範圍，因 貴公司遵循 FATCA 及協議之目的，貴公司亦得於 FATCA 及協議所規定及要求之範圍及期間內，在國內、外地區以自動化機器或其他非自動化之方式，對國內、外有關調查機關、金融監理機關或其他政府機關，利用本人之個人資料。
本人聲明，本人知悉得自由選擇是否提供此同意，惟本人若拒絕提供此同意， 貴公司將無法進行必要之審核及處理作業，致無法提供本人相關服務，並基此瞭解同意無誤。
此致
日盛期貨股份有限公司
立同意書人： 簽章
身分證字號：
地 址：
中 華 民 國 年 月 日
日盛期貨履行個人資料保護法第八條第一項告知義務內容
ㄧ、親愛的客戶您好，由於個人資料之蒐集，涉及 臺端的隱私權益，日盛期貨股份有限公司(以下稱本公司)向 臺端蒐集個人資料時，依據個人資料保護法(以下稱個資法)第八條第一項規定，應明確告知 臺端下列事項：
（一）非公務機關名稱（二）蒐集之目的（三）個人資料之類別（四）個人資料利用之期間、地區、對象及方式（五）當事人依個資法第三條規定得行使之權利及方式（六）當事人得自由選擇提供個人資料時，不提供將對其權益之影響。
二、有關本公司蒐集 臺端個人資料之目的、個人資料類別及個人資料利用之期間、地區、對象及方式等內容，請 臺端詳閱如後附表。三、依據個資法第三條規定，臺端就本公司保有 臺端之個人資料得行使下列權利：
（一）除有個資法第十條所規定之例外情形外，得向本公司查詢、請求閱覽或請求製給複製本，惟本公司依個資法第十四條規定得酌收必要成本費用。
（二）得向本公司請求補充或更正，惟依個資法施行細則第十九條規定，臺端應適當釋明其原因及事實。
（三）本公司如有違反個資法規定蒐集、處理或利用 臺端之個人資料，依個資法第十一條第四項規定，臺端得向本公司請求停止蒐集。
（四）依個資法第十一條第二項規定，個人資料正確性有爭議者，得向本公司請求停止處理或利用 臺端之個人資料。惟依該項但書規定，本公司因執行業務所必須並註明其爭議或經 臺端書面同意者，不在此限。
（五）依個資法第十一條第三項規定，個人資料蒐集之特定目的消失或期限屆滿時，得向本公司請求刪除、停止處理或利用 臺端之個人資料。惟依該項但書規定，本公司因執行業務所必須或經 臺端書面同意者，不在此限。
四、臺端如欲行使上述個資法第三條規定之各項權利，有關如何行使之方式，得向本公司客服(00)0000-0000 洽詢。
五、臺端得自由選擇是否提供相關個人資料及類別，惟 臺端所拒絕提供之個人資料及類別，如果是辦理業務審核或作業所需之資料，本公司可能無法進行必要之業務審核或作業而無法提供 臺端相關服務或無法提供較佳之服務，敬請見諒。
附表：
特定目的說明 | 蒐集之個人資料類別 | ||
業務類別 | 業務特定目的及代號 | 共通特定目的及代號 | |
期貨經紀、期貨經理、期貨顧問、期貨信託、證券交易輔助人及境外華僑及外國人代理人等相關金融業務 | 068 信託業務 166 證券、期貨、證券投資信託及顧問相關業務 181 其他經營合於營業登記項目或組織章程所定之業務 182 其他諮詢與顧問服務 | 040 行銷 059 金融服務業依法令規定及金融監理需要，所為之蒐集處理及利用 060 金融爭議處理 061 金融監督、管理與檢查 063 非公務機關依法定義務所進行個人資料之蒐集處理及利用 069 契約、類似契約或其他法律關係管理之事務 090 消費者、客戶管理與服務 091 消費者保護 098 商業與技術資訊 104 帳務管理及債權交易業務 136 資(通)訊與資料庫管理 137 資通安全與管理 157 調查、統計與研究分析 177 其他金融管理業務 | 姓名、國籍、身分證統一編號、性別、出生地、出生年月日、戶籍資料、住居所、通訊方式、職業及其他詳如相關業務申請書或契約書之內容，並以本公司與客戶往來之相關業務、帳戶或服務及自客戶或第三人處所實際蒐集之個人資料為準。 |
個人資料利用之期間 | 個人資料利用之地區 | 個人資料利用之對象 | 個人資料利用之方式 |
ㄧ、特定目的存續期間。 二、依相關法令所定（例如商業會計法等)或因執行業務所必須之保存期間或依個別契約就資料之保存所定之保存年限。 （以期限最長者為準） | 右邊「個人資料利用之對象」欄位所列之利用對象其國內及國外所在地。 | ㄧ、本公司(含受本公司委託處理事務之委外機構) 、本公司之分公司、與本公司有從屬關係之子公司或有控制關係之母公司暨其分公司或集團關係之公司、或與本公司或前述公司因業務需要訂有契約關係或業務往來之機構（含共同行銷、合作推廣等）或顧問（如律師、會計師）、或主管機關許可受讓證券商全部或部分業務之受讓人。 二、依國內外法令規定利用之機構。 三、其他業務相關之機構（例如：期貨交易所、同業公會等依法令授權辦理股務事務之相關機構及其他經目的事業主管機關指定，包含在業務經營上，與監督管理檢查、買賣、徵信、交易、交割等有關之相關機構）。 四、依國內外法令有權機關或金融監理機關及對第一點所列利用對象有管轄權之金融監理機構與依法行使公權力之機關。 五、客戶所同意之對象（例如本公司共同行銷或交互運用客戶資料之公司、與本公司合作推廣業務之 公司等）。 | 符合個人資料保護相關法令以自動化機器或其他非自動化之利用方式。 |
簽章)
本公司xx依個人資料保護法第八條履行告知義務，告知當事人(受告知人：
營業員： (印章)