Entity Tax Self-Certification Form (Page 4 of 4) in pdf

ENTITY TAX SELF-CERTIFICATION FORM

Why is all this information being asked?

Under the Intergovernmental Agreement between Canada and the United States of America

(“Canadian IGA”), Canadian ﬁ nancial institutions are

required to collect and report information on their account holders who are U.S. citizens and/or U.S. residents for U.S. tax purposes to the Canada

Revenue Agency (CRA), and certain U.S. citizens and U.S. residents for U.S. tax purposes who are considered controlling persons of an entity with a

ﬁ nancial account. Under the Canadian IGA, the CRA would exchange this information with the U.S. Internal Revenue Service (IRS). As a result, Canadian

ﬁ nancial institutions are required to ask for the tax status of an entity account holder and certain information on any controlling persons of the entity who

are considered U.S. persons. Please advise your registered dealer immediately if the entity or any controlling persons have a change in circumstances of

the information provided in the Entity Tax Self-Certiﬁ cation form.

Requirement to provide Taxpayer Identiﬁ cation Number(s) (TIN)

Under the Income Tax Act (Canada), the CRA may impose a penalty if you fail to provide the Canadian ﬁ nancial institution with the requested Social

Insurance Number (SIN), Business Number (BN) or the U.S. TIN, as applicable. If you are a (speciﬁ ed) U.S. person and you do not have a U.S. TIN,

penalties will not be assessed if an application for the assignment of the U.S. TIN is made within 90 days of the request and provided to your registered

dealer within 15 days of receipt.

Will the account be reported?

In general, an account will be reported if the account holder is a speciﬁ ed U.S. person, a Passive NFFE with U.S. Person(s) as controlling person(s) or a

NPFI. In addition, an account may also be reported if the account holder fails to provide the necessary documentation as requested by your registered

dealer, even though the account holder may not be a speciﬁ ed U.S. person, a Passive NFFE with U.S. Person(s) as a controlling person(s) or a NPFI.

To the extent an account is reportable, under the Canadian IGA, the ﬁ nancial institution will report the account information to the CRA. The CRA may

then provide this information to the IRS in accordance with the provisions of the Canada-U.S. Tax Convention.

Where can I obtain further information?

For further information, please visit the CRA website at or the IRS website at

Footnotes

A controlling person may include:

• Any shareholder or partner who directly or indirectly owns 25% or more of a corporation or a partnership.

• Any beneﬁ ciary (regardless of % of ownership interest), trustee or settlor of a trust.

Agreement Between the Government of the United States of America and the Government of Canada to Improve International Tax Compliance through Enhanced Exchange

of Information under the Convention Between the United States of America and Canada with Respect to Taxes on Income and on Capital.