Self-Certification Form for Individuals

Please complete the relevant sections below and provide any additional information as may be required. Kindly refer to the summary definitions and/or contact your tax advisor if you need assistance to complete this form.

In certain circumstances there may be a requirement to pass on the information in this form and other financial information with respect to the financial accounts to Her Majesty’s Revenue and Customs (HMRC). HMRC will in turn be obliged to pass this information to the relevant Competent Authorities.


Section A: Individual Account Holder Information

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Country of Birth
Current Residence Address(Required)
(Do not use P.O box or an ‘in care of’ address)
Mailing Address
(if different to current residence address above)
Are you a US person?(Required)

Section B: Individual Account Holder Tax Residence Information

Please indicate ALL countries in which the individual account holder is resident for tax purposes and the relevant Tax Identification Number (or functional equivalent). Please list all countries of tax residence in the table below.

If the individual account holder is a US resident or citizen, or hold a US passport or green card (even if you living outside the US), please also include United States in the table below along with the US Tax Identification Number. If the individual account holder is tax resident in more than three countries, please use a separate sheet to list the additional tax residency(ies).

List(Required)
Country(ies) of Tax Residence
Tax Identification Number(s) / Functional Equivalent
If unavailable please specify a reason* (Enter A, B or C. If B is entered please provide an explanation)
 

* If a Tax Identification Number (TIN) is unavailable, please provide the appropriate reason A, B or C in the table above, with a written explanation for reason B:

Reason A: The country where the individual account holder is liable to pay tax does not issue TINs to its residents.

Reason B: The individual account holder is otherwise unable to obtain a TIN or equivalent number, please explain why, in the table above.

Reason C: No TIN is required. Note: only select this reason if the domestic law of the relevant jurisdiction does not require the collection of TINs issued by such jurisdiction.

Declaration

I understand that the information supplied by me is covered by the full provisions of the terms and conditions governing the Account Holder’s relationship with National Bank of Egypt UK (or an affiliate thereof) (“National Bank of Egypt UK”), setting out how National Bank of Egypt UK may use and share the information supplied by me.

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

I acknowledge that the information contained in this form and information regarding the account maintained with National Bank of Egypt UK may be provided to Her Majesty’s Revenue and Customs (HMRC). HMRC will in turn exchange this information with tax authorities of other countries.

I undertake to advise National Bank of Egypt UK promptly of any change in circumstance which causes the information contained herein to become incorrect or incomplete and to provide National Bank of Egypt UK with an updated declaration immediately or no later than thirty (30) days of such a change in circumstance.

If you are not the account holder please indicate the capacity in which you are signing the form. A legal guardian should complete the form on behalf of a minor. If signing under a power of attorney, please also attach a certified copy of the power of attorney.
Accepted file types: pdf, doc, docx, Max. file size: 2 MB.
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Summary Definitions

These are selected summaries of defined terms provided to assist you with the completion of this form.

For further detail please refer to the OECD Common Reporting Standard for Automatic Exchange of Financial
Account Information (CRS), the associated Commentary to the CRS, the IRS FATCA Regulations and/or
domestic legislation and guidance.

If you have any questions please contact your tax adviser or domestic tax authority

TermDefinition summary
Account
Holder
The “Account Holder” is the person listed or identified as the holder of a Financial
Account. A person, other than a Financial Institution, holding a Financial Account for
the benefit of another person as an agent, a custodian, a nominee, a signatory, an
investment advisor, an intermediary, or as a legal guardian, is not treated as the
Account Holder. In these circumstances that other person is the Account Holder. For
example, in the case of a parent/child relationship where the parent is acting as a
legal guardian, the child is regarded as the Account Holder. With respect to a jointly
held account, each joint holder is treated as an Account Holder.
Financial AccountFor purposes of FATCA and CRS, a Financial Account is an account maintained by a
Financial Institution and includes: Depository Accounts; Custodial Accounts; Equity
and Debt Interest in certain Investment Entities; Cash Value Insurance Contracts; and
Annuity Contracts.
Tax residenceEach jurisdiction has its own rules for defining tax residence, and some jurisdictions
have provided information on how to determine whether an individual is tax resident
in the jurisdiction on the following website: OECD AEOI Portal.

Note: an individual may have duel or multiple tax residence
Tax Identificaiton
Number
The term “TIN” means Taxpayer Identification Number (or functional equivalent in
the absence of a Taxpayer Identification Number).

Some jurisdictions do not issue a TIN. However, these jurisdictions often utilize some
other high integrity number with an equivalent level of identification (a “functional
equivalent”). Examples of that type of number include, for individuals, a social
security/insurance number, citizen/personal identification/service code/number, and
resident registration number.
US PersonThe term U.S. Person” means a U.S. citizen or resident individual, a partnership or
corporation organized in the United States or under the laws of the United States or
any State thereof, a trust if

(i) a court within the United States would have authority under applicable law to
render orders or judgments concerning substantially all issues regarding
administration of the trust; and (ii) one or more U.S. persons have the authority to
control all substantial decisions of the trust, or an estate of a decedent that is a citizen
or resident of the United States.

The term U.S. Person shall be interpreted in accordance with the U.S. Internal Revenue
Code.