Common Reporting Standard ("Crs") Self-Certification Form
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1PHILLIP FUTURES SDN BHD
(362533-U) (CMSL/A0233/2008)
B-2-6, Block B, Level 2, Unit 6, Megan Avenue II, No. 12, Jalan Yap Kwan Seng, 50450 Kuala Lumpur.
Tel: (+603) 2162 1628
Fax: (+603) 2162 1678
E-mail: .my
The following declaration is to be completed and attached with the Phillip Futures Account Opening Form.
COMMON REPORTING STANDARD (“CRS”) SELF-CERTIFICATION FORM
Section A : For Individual and Corporate, please complete declaration below.
I / We declare that I / We are
Tax resident in Malaysia ONLY. Please leave the following table empty.
Foreign tax resident (other than Malaysia). Please list ALL the countries in which you are foreign tax resident in the following table:
Name
Country of Tax Residence
Tax Identification No
Section B : For Corporate which is Non Financial Institution ONLY, please complete declaration below.
I / We declare that I / We are
Active NFE
Passive NFE. Please list ALL Controlling Person(s) with tax residency other than Malaysia in the
following table:
Date of
Country of Tax
Tax Identification
Name of Controlling Person
Residence Address
Birth
Residence
No
Declaration
I / We declare that I have examined the information on this form and to the best of my knowledge and belief, it is true, correct, and complete.
I / We hereby acknowledge and consent that Phillip Futures Sdn Bhd (PFSB) shall have the right to provide my / our personal data and
information to regulatory authorities in accordance with the requirements of Common Reporting Standard (CRS) for the Automatic Exchange
of Financial Account Information as may be stipulated by applicable laws, regulations, agreement or regulatory guidelines or directives.
If there is any update to the account information/ tax residency status or if updates reveal any change of tax residency status, I / We hereby
agree to notify and furnish PFSB with the relevant documentary evidence within 30 days of such change.
I certify that I am the Account Holder (or am authorised to sign for the Account Holder) of all the account(s) to which this form relates.
__________________________
______________________
Common Seal/Company’s Stamp
Signature of Client/Authorised Signatories
Name :
Date :
Definitions:
The term “Financial Institution” means a Depository Institution, Custodial Institution, Investment Entity or a Specified Insurance Company. Please refer to
(1)
the CRS guidance available in Lembaga Hasil Dalam Negeri (LHDN) website for further information.
The term “NFE” refers to “Non Financial Entities”, which means entity that is not a Financial Institution.
(2)
The term “Active NFE” means entities that :
(3)
(a)
do NOT primarily receive passive income or primarily hold amounts of assets that produce passive income (such as dividends, interest, rents etc.).
(b)
include entities that are publicly traded (or related to a publicly traded entity), Governmental Entities, International Organisations, Central Banks, or
a holding NFEs of non financial groups.
The term “Passive NFE” means any NFE that is not an Active NFE. An Investment Entity located in a Non-Participating Jurisdiction is treated as a Passive
(4)
NFE for purposes of the CRS.
The term “Controlling Person” means a natural person who exercise control over an entity. If the Controlling Person(s) of Passive NFE who hold directly/
(5)
indirectly more than 25% of the shares/ voting rights are foreign tax resident(s), please list all the countries in which the Controlling Person(s) are foreign
tax resident(s).
(6)
A U.S. citizen is considered a tax resident of the United States even if he / she is a tax resident of another jurisdiction. If you are a tax resident of the United
States, please provide your U.S. TIN using Form W-9.
VERSION : CRS001072017
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