Appendix 3

Foreign Account Tax Compliance Act (FATCA) and Common Reporting Standards (CRS)
Self-Certification Form for Entities

This is a self-certification form ("Certification Form") that you will need to complete and provide to OCBC Bank
(Malaysia) Berhad / OCBC Al-Amin Berhad (herein defined as “OCBC Bank” or “the Bank”) for the purpose of
complying with relevant tax regulations to enable the automatic exchange of financial account information
("AEOI").

The data collected may be reported by the Bank, directly or indirectly, to relevant tax authorities.

The Bank does not and cannot provide any tax advice. If you have any questions about how to complete this form,
please consult your tax advisor. This form is intended to assist the Customer and the Bank in identifying and
classifying each account holder's tax status and to complete the documentation necessary for compliance with
relevant AEOI tax regulations, including the US Foreign Account Tax Compliance Act ("FATCA") and the OECD
Common Reporting Standard for Automatic Exchange of Financial Account Information in Tax Matters, as
implemented in relevant jurisdictions ("CRS").

Mandatory fields are marked with an *.

Section 1: Entity Identification

A. Name of Entity*:

B. Country of incorporation or organization*:

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C. Registered Address*:

Country: Postal Code:

D. Business Address (please complete if it is different from the address in C):

Country: Postal Code:

Section 2: US Foreign Account Tax Compliance Act (“FATCA”) Self-Certification for Entities

(The information provided in this section is for FATCA purposes, please note your classification may differ from your CRS
classification in Section 3)

This self-certification form is NOT required if: (Please tick where applicable )

 you are incorporated, established, constituted or organised in the United States (“US”), please submit
US IRS Form W-9 instead

 you are a financial institution, please submit US IRS Form W-8BEN-E or relevant US IRS Form W-8
where applicable (this includes licensed entities under the Labuan Financial Services and Securities
Act 2010 or Labuan Islamic Financial Services and Securities Act 2010)

 you are able to upfront provide a relevant US IRS W-8 Form

 you are sole-proprietorship owned by individual. Please complete OCBC Individual Self-
Certification Form

For all other entities including sole-proprietorship owned by business entity, please complete Section 2.1.

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Section 2.1 FATCA Classification

Please select one of the following statements that best describes your entity.

Option Description FATCA

Classification

 Publicly Listed Company and Its Related Entity

1
 The Entity is not a financial institution , and
 The Entity‟s (including an Affiliate of an entity) stock is regularly traded
2
on one or more established securities markets , including
________________________________________
(Name all securities markets on which the Entity‟s stock is regularly
traded).

________________________________________
Active NFFE
(If you are a Related Entity of a regularly traded corporation, please
provide the name of the regularly traded corporation that the Entity is
related to)

 Active Business
 The Entity is not a financial institution, and
 The Entity is the business of
_______________________________________________.
 The Entity derives at least 50% of its income from these business
3
activities and not from passive income such as investments, dividends,
interests, rents or royalties.

 Non- US Public Sector Entity Active NFFE

 The Entity is any of the following:
 Central Banks
 Government Agencies
 Statutory Boards
 Entities owned by Statutory Boards
 Public Sector entities
 Foreign Embassies or Trade Representative Offices
 International Organizations

 Charity or Non-Profit Organisation Active NFFE

 The Entity is a Charity / Non-Profit Organisation (including charitable
Trusts)

 Passive Investments Passive NFFE

 The Entity is not a financial institution
 The Entity is in the business of
_______________________________________________.
The Entity derives at least 50% of from passive income such as
investments, dividends, interests, rents or royalties.

  The Entity is none of the above. Please specify:

I/We will complete and submit the US IRS Form W-8BEN-E together with
this Certification Form along with any relevant supporting documents/
information.

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Section 3: Common Reporting Standard (CRS) Self-Certification for Entities

(The information provided in this section is for CRS purposes, please note your classification may differ from your FATCA
classification in Section 2)

Section 3.1 CRS Classification

Please select one of the following statements that best describes your entity.

Option Description CRS

Classification

 Publicly Listed Company and Its Related Entity Active NFE -

1
 The Entity is not a financial institution , and Publicly Traded
 The Entity‟s (including an Affiliate of an entity) stock is regularly traded
2
on one or more established securities markets , including
________________________________________
(Name all securities markets on which the Entity‟s stock is regularly
traded).

________________________________________
(If you are a Related Entity of a regularly traded corporation, please
provide the name of the regularly traded corporation that the Entity is
related to)

 Active Business Active NFE

 The Entity is not a financial institution, and
 The Entity is the business of
_______________________________________________.
 The Entity derives at least 50% of its income from these business
3
activities and not from passive income such as investments, dividends,
interests, rents or royalties.

 Public Sector Entity Active NFE -

 The Entity is any of the following: Government
 Central Banks Entity or Central
 Government Agencies Bank
 Statutory Boards
 Entities owned by Statutory Boards
 Public Sector entities
 Foreign Embassies or Trade Representative Offices
 International Organizations

 Charity or Non-Profit Organisation Active NFE –

 The Entity is a Charity / Non-profit Organisation (including charitable Start-Up NFE or
trusts) Non-Profit NFE

 Financial Institution FI-Custodial,

 Depository Institution, Custodial Institution or Specified Insurance Depository
Company Institution,
Specified
Insurance
Company

 Financial Institution- Investment Entity FI-Investment

 Investment Entity located in a Non-Participating Jurisdiction and Entity (non-
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managed by another Financial Institution (If this is ticked, please participating)

complete Section 3.3)

E.g. Trust that is an Investment Entity where the trustee is located in a Non-
4
Participating Jurisdiction

 Financial Institution- Investment Entity Other

 Other Investment Entity (including Investment Entity located in a Investment
4
Participating Jurisdiction and managed by another Financial Institution) Entity

 Passive Entity Passive NFE

 The Entity is not a financial institution
 The Entity is in the business of
_______________________________________________.
3
The Entity derives at least 50% of from passive income such as
investments, dividends, interests, rents or royalties.

OR

Trust that is not professionally managed by another Financial Institution

(If this is ticked, please complete Section 3.3)

Section 3.2 CRS Declaration of Tax Residency(ies)

Please tick one or more

 Malaysia

 Others (Please complete the table below)

Country of Tax Residence Taxpayer Identification If no TIN, indicate reason

No. (TIN)
 A – Country does not issue TIN
 B – TIN not required to be collected
 C – Not able to obtain one/others, please
specify reason:
 A – Country does not issue TIN
 B – TIN not required to be collected
 C – Not able to obtain one/others, please
specify reason:
 A – Country does not issue TIN
 B – TIN not required to be collected
 C – Not able to obtain one/others, please
specify reason:
If you are not a tax resident in any jurisdiction (e.g. fiscally transparent), indicate the jurisdiction in which your place of effective
management is situated. If you have more than three countries/jurisdictions, please attach a separate sheet.

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Section 3.2 (i) For Entity

If any of the following areas listed below differs from your country(ies) of tax resident, please provide an
explanation (you may tick more than one area)

 Country(ies) of  The place of effective management of my entity is different from its place
incorporation/registration of incorporation/registration.

(If your tax residence is not  The entity is a branch and its head office is tax resident in the declared
where you are country of tax residence.
incorporated/registered, please
provide a government issued  The entity is set up by a service provider (e.g. lawyer/corporate
document of at least one of the secretary/accountant/fund manager/administrator/related entity, etc.)
country(ies) which you are a tax
resident of  Others (please provide explanation):

 Mailing Address(es)  This is the address of my business operation / service provider (e.g.
lawyer/corporate secretary/accountant/fund manager/fund administrator,
etc.).

 That is the address of our director/shareholder/authorised signatory.

 Others (please provide explanation):

 Country of domicile  My tax residency is determined by the place of incorporation which is

different from my place of business (only applicable if country of incorporation
(place of business) is one of the tax residency(ies)).

 Others (please provide explanation):

1
Financial Institution‟ refers to any entity that:
a) Accepts deposits in the ordinary course of a banking or similar business; or
b) Holds, as a substantial portion of its business, financial assets for the account of others; or
c) Is an investment entity; or
d) Is an insurance company (or a holding company that is a member of an expanded affiliated group that includes an insurance com pany), and
the insurance company (or holding company) issues, or is obligated to make payments with respect to, a cash value insurance or annuity
contract
2
An “established securities market” generally refers to a Securities exchange that; (i) is officially recognized, sanctioned, or supervised by a governmental
authority of the foreign country in which the market is located; and (ii) has an annual value of shares traded on the exchange (or a predecessor exchange)
exceeding $1 billion during each of the three calendar years immediately preceding the year in which the determination is being made.

3„
Passive income‟ refers generally to the portion of gross income that consists of: dividends (including substitute dividend payments); interest; income
equivalent to interest; rents and royalties (other than those derived in the active conduct of a trade or business conducted, at least in part, by employees);
annuities; net gains from the sale of property that gives rise to passive income; net gains from certain transaction in commodities; net foreign currency gains;
net income from notional principal contracts; amounts received under cash value insurance contracts; and amounts received by an insurance company in
connection with its reserves for insurance and annuity contracts.

4
For a list of countries participating in the CRS, please see the OECD CRS portal: http://www.oecd.org/tax/automatic-exchange/commitment-and-
monitoring-process/

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Section 3.3 Ultimate Beneficial Owners (Controlling Persons) of a Passive NFE/Investment Entity (Non-
Participating)/Trust/Client Account

Please provide the details of each Ultimate Beneficial Owner (Controlling Person) of the Passive NFE /
Investment Entity (Non-Participating) / Trust / Client Account in the table below.

If you are a tax resident in more than one country, please detail all countries of Tax Residence and associated
TINs in separate rows for each country of tax residence.

Controlling Person 1 Controlling Person 2 Controlling Person 3

Name
(as per NRIC)

NRIC/Passport
No.

Date of Birth

Controlling person Please tick one only Please tick one only Please tick one only
type
Legal Person Legal Person Legal Person
 Control by ownership  Control by ownership  Control by ownership
 Control by other means  Control by other means  Control by other means
 Senior managing official  Senior managing official  Senior managing official

Trust Trust Trust

 Settlor  Settlor  Settlor
 Trustee  Trustee  Trustee
 Protector  Protector  Protector
 Beneficiary  Beneficiary  Beneficiary
Others Others Others

Legal Arrangement (Non- Legal Arrangement (Non- Legal Arrangement (Non-

Trust) Trust) Trust)
 Settlor- equivalent  Settlor- equivalent  Settlor- equivalent
 Trustee- equivalent  Trustee- equivalent  Trustee- equivalent
 Protector- equivalent  Protector- equivalent  Protector- equivalent
 Beneficiary- equivalent  Beneficiary- equivalent  Beneficiary- equivalent
 Others  Others  Others
Contact Number

Residential
Address

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________________ ________________ ________________

Postal Code Postal Code Postal Code

________________ ________________ ________________

Country Country Country

Country of Tax
i. i. i.
Residency
ii. ii. ii.
iii. iii. iii.
TIN
i. i. i.
(If you are solely a
Malaysian tax ii. ii. ii.
resident, you do not
need to provide a iii. iii. iii.
TIN)

If no TIN, indicate  A – Country does not  A – Country does not  A – Country does not
reason issue TIN issue TIN issue TIN
 B – TIN not required to  B – TIN not required to  B – TIN not required to
be collected be collected be collected
 C – Not able to obtain  C – Not able to obtain  C – Not able to obtain
one/others, please specify one/others, please specify one/others, please specify
reason: reason: reason:
If the list is more than spaces provided, please attach separate listing and furnish certified true copies of their identity
documents.

Please be aware that depending on your CRS declaration, you might be reported to the Malaysian tax authority
(i.e. Inland Revenue Board of Malaysia) who will then exchange such information with the relevant foreign
competent tax authority(ies) of the country(ies) in which you are resident for tax purposes, in accordance with the
law dated 23 December 2016, relating to the Common Reporting Standard.

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Section 4: Agreement

I/We confirm that all the information I/we have provided is true, accurate and complete and I/we have not withheld
any information. I/We undertake to keep OCBC Bank informed in writing, within 30 days, of any changes in
circumstances that may cause any of the information in this Certification Form to become incorrect or incomplete
and also undertake to provide any other additional information as may be required by OCBC Bank and/or
applicable law.

The person named and signing below are duly authorised to complete and sign this Certification Form for and on
behalf of the Entity and the Controlling Person(s) (if applicable) and to submit this Certification Form to OCBC
Bank.

Signature:

Name :

NRIC/Passport Number:

Date:

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For Bank use only

1. CRS classification 5. Other reasons (Section

(Section 3.1) 3.2)

2. Tax country (Section 6. For entity(ies)

3.2)
Reasonableness Test
(Section 3.2 (i))

3. TIN (Section 3.2) 7. Controlling person

Is customer a Passive Yes

NFE/Trust that is not
professionally managed by No
another Financial Institution?
(Section 3.3)

4. Reasons for not having

TIN (Section 3.2)

Notes:
 1. & 2. are mandatory fields
 3. is required if tax country is NOT Malaysia
 3. is not required if tax country is Malaysia or tax country does not provide TIN
 6. “Reasonableness Test” justification is required to be input if RT screen pops up i.e. customer failed RT
 1. to 7. cannot be left empty. Please indicate N/A if not applicable

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