Self-Certification For Common Reporting Standard (Crs) Page 4
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Section 5: Individual Declaration and Signature
To be signed by each individual who is a Controlling Person as specified in the
Application at Part C: Beneficial Owners
I understand that the information supplied by me is covered by the full provisions of the
terms and conditions governing my relationship with Sharefunds Limited setting out how
Sharefunds Limited may use and share the information supplied by me.
I acknowledge that the information contained in this form and information regarding
the account holder and any Reportable Account(s) may be reported 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.
I certify that I am the Account Holder (or am authorised to sign for the Account Holder)
of all the accounts to which this form relates
I declare that all statements made in this declaration are, to the best of my
knowledge and belief, correct and complete.
I undertake to advise Sharefunds Limited within 30 days of any change in
circumstances which affects the tax residency status of the Account Holder identified
in Section 1 of this self-certification form or if the information provided becomes
incorrect or incomplete and to provide Sharefunds Limited with a suitably updated
self-certification and Declaration within 30 days of such change in circumstances.
Signature
Print name
Date
If signing under a power of attorney please also attach a certified copy of the power
of attorney.
Capacity
Sharefunds Limited is authorised and regulated by the Financial Conduct Authority and is entered on the register under reference 227807
Registered in England – Number 04856420
Registered Office: Bow House, 1A Bow Lane, London, EC4M 9EE
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