FATCA-CRS ANNEXURE– INDIVIDUALS

(INCLUDING SOLE PROPRIETORS)

(Please consult your professional tax advisor for further guidance on your tax residency, if required)

Details under FATCA / CRS to be filled by each Policyholder/Beneficiary (All fields in this form are Mandatory)

Error

Error

Submit

Error

Error

Error

Are you a tax resident of country other than India?

If ‘Yes’ please provide the country name

Error

Are you holding citizenship of any other country?

If ‘Yes’ please provide the country name

Error

Country of Birth

If ‘Other’ please provide the country name

Error

Are you of Indian Origin?

If ‘No’ Specify Origin

Error

Country of Current Residence

If ‘Other’ please provide the country name

Error

Contact details while abroad (other than India)

Type of Address

Error

Error

Error

Error

Error

Error

Error

Telephone No's:

Error

Error

Error

Tax details of other countries (Please indicate all countries in which you are resident for tax purposes and associated details)

Error

Error

Error

Error

Error

Error

Error

Error

Error

# To also include USA, where the individual is a citizen/ green card holder of USA

% In case Tax Identification Number is not available, kindly provide functional equivalent$

CERTIFICATION

I under penalty of perjury, I certify that:

  • I understand that Edelweiss Tokio Life Insurance Co. Ltd. is relying on this information for the purpose of determining the status of the applicant named above in compliance with FATCA/CRS. Edelweiss Tokio Life Insurance Co. Ltd. is not able to offer any tax advice on FATCA or CRS or its impact me. I have sought/ shall seek advice from professional tax advisor for any tax questions.
  • I agree to submit a new form within 30 days if any information or certification on this form becomes incorrect.
  • I agree that as may be required by domestic regulators/tax authorities, Edelweiss Tokio Life Insurance Co. Ltd. may also be required to report, reportable details to CBDT or other authorities/agencies or close or suspend my account, as appropriate.
  • I have understood the information requirements of this Form (read along with the FATCA/CRS Instructions) and hereby confirm that the information provided by me on this Form including the taxpayer identification number is true, correct, and complete. I also confirm that I have read and understood the FATCA/CRS Terms and Conditions below and hereby accept the same.