Remarks and Declaration for Part 2: Tax Residence for the Country(ies) other than US
^The information provided here would not supersede all previous ones. All previous tax residence information provided (as the case may be) should remain unchanged.
*If a TIN is unavailable, please provide the appropriate reason A or B as indicated below:
- Reason A: The country/ jurisdiction where the Account Holder is resident for tax purpose but does not issue TINs to the Account Holder
- Reason B: No TIN is required (Note: Only select this reason if the authorities of the country/ jurisdiction of tax residence entered above do not require the TIN to be disclosed)
The above certification is specifically required with respect to the collection, retention and use of the above data as necessarily required in section 50C(3) of the Inland Revenue Ordinance for a reportable account and a non-reportable account for the purpose of automatic exchange of financial account information.
I acknowledge and agree that (i) the information contained in this certification is collected and may be kept by the financial institution for the purpose of automatic exchange of financial account information, and (ii) 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 of the People's Republic of China in which the account(s) is/are maintained and exchanged with tax authorities of another jurisdiction or jurisdictions in which the account holder may be resident for tax purposes pursuant to the competent authority agreements to exchange financial account information.
I also acknowledge that it is an offence under the Inland Revenue Ordinance if any person, in making a self-certification, makes a statement that is misleading, false or incorrect in a material particular knowingly or in a reckless manner. A person who commits the offence is liable on conviction to a fine at level 3 (i.e. HKD10,000).
Nationality should be included as one of the Country/Jurisdiction of Tax Residence. If not, please state the reasons: