Corporate FATCA Self Certification

The Foreign Account Tax Compliance Act (FATCA), which is part of the US Hiring Incentives to Restore Employment Act of 2010, aims to combat tax evasion by US tax residents using foreign accounts. It includes certain provisions on withholding taxes and requires financial institutions outside the US to pass information about their US customers to the US tax authorities, the Internal Revenue Services.

If you do not have room to answer the below questions fully or wish to provide additional information please use the ‘Additional information’ box at bottom of form.
Name*
First Last
Account Number*
Country of Registration*
Country
Country of business address*
Country
US TIN (Taxpayers Identification Number)*
GIIN (Global Intermediary Identification Number) ref number*
Company Tax residencies*
Name Tax id
FACTA Classification*
If your company is an NFFE ( Non Financial Foreign Entity) and is a ‘Passive NFFE’ then please supply the below information for each beneficial owner and controlling director/ officer:
Nationality*
If Dual Nationality, state both or all nationalities:
Do you have U.S.A. Citizenship:*
- Yes
- No
Country of trading residence*
Country
Correspondence Address*
Street Address Address Line 2 Town / City County / State / Region Postal / ZIP Code Country
Place of birth*
Date of birth*
DD slash MM slash YYYY
Are you subject to U.S.A. tax?*
- Yes
- No
Do you have a U.S.A. "Green Card"?*
- Yes
- No
Do you have a FATCA status?*
- Yes
- No
Work Phone Number
Direct/mobile phone number*
Home phone number
I am aware that in certain circumstances National Bank of Egypt UK will be obliged to share this information with UK tax authorities, who may pass it on to other tax authorities. I acknowledge and agree that information contained in this form and information regarding income paid or credited to or for the benefit of the account(s) — set out above may be reported to the tax authorities of the country in which such income arises and that those tax authorities may provide the information to the country or countries in which the individual/entity is resident for tax purposes.

I authorise National Bank of Egypt UK to provide, directly or indirectly, a copy of this form and information regarding income paid or credited to or for the benefit of the account(s) set out above to: (i) any person that has control, receipt, or custody of income to which this form relates; (ii) any person that can disburse or make payments of income to which this form relates; or (iii) any party authorised to audit or conduct a similar control of aforementioned persons for tax purposes.

I declare that the information provided in this form is, to the best of my knowledge and belief, accurate and complete.

I undertake to advise National Bank of Egypt UK promptly of any change in circumstances which causes the information contained herein to become incorrect or incomplete and to provide National Bank of Egypt UK with an updated declaration within 30 days of such a change in circumstances.
Name
First Last
Position
Date
MM slash DD slash YYYY
Additional information
Definitions

Active Non-Financial Foreign Entity (Active NFFE)

The term Active NFFE refers to an entity that operates an active trade or business other than that of a financial business. An Active NFFE is defined under FATCA as follows:

a) The company is not incorporated, created or organised in the United State of America or under the law of the U.S.A. or any States of the U.S.A., including Columbia; and
b) The company is not a Financial Institution; and
c) Less than 50 % of the company’s gross income for the preceding calendar year or other reporting period is passive income, and less than 50% of the assets held by the entity during the preceding calendar year or reporting period are assets that produce or are held for the production of passive income.

Passive Income

Dividends, interest on accounts and investments, Annuities, gains in financial products related to commodities, certain foreign currency exchange gains, amounts received under cash value insurance contracts and annuity contracts; and net gains from the sale of assets that give rise to the above types of income. Passive Income excludes:
Any income from interest, dividends, rents or royalties that is received from a related person where the amount is properly allocable to income of such related person that is not passive income. Income generated by commodities or securities dealers in the ordinary course of business.

Passive Entity Passive NFFE

Entities organisations or companies that are receiving passive income or hold passive assets and do not fall under any other FATCA classifications. These entities, companies do not carry on the business of a Financial Institution.
Consent*
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75599

Name	Tax id