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Get Self Certification Form For Jamaica National

I undertake to advise the recipient promptly and provide an updated Self-Certification form within 30 days where any change in circumstances occurs which causes any of the information contained in this form to be inaccurate or incomplete. Where legally obliged to do so I hereby consent to the recipient sharing this information with the TAX ADMINISTRATION JAMAICA TAJ. Signature Date dd/mm/yyyy JAMAICA NATIONAL BUILDING SOCIETY is obliged under the Intergovernmental Agreements IGA entered into by the Jamaica and the United States of America in relation to the automatic exchange of information for tax matters FATCA to collect certain information about each account holder. Individual Self-Certification Section 1 Account Holder Identification Account Holder Name Date of Birth dd/mm/yyyy Country of Birth Permanent Residence Address Number Street City/Town State/Province/County Post Code Country Mailing address if different from above Section 2 Declaration of U*S* Citizenship or U*S* Residence for Tax purposes Please tick either a or b or c and complete as appropriate. a I confirm that I am a U*S* citizen and/or resident in the U*S* for tax purposes green card holder or resident under the substantial presence test and my U*S* federal taxpayer identifying number U*S* TIN is as follows surrendered my citizenship as evidenced by the attached documents. Complete this section if you have non-U*S* tax residencies. I hereby confirm that I am for tax purposes resident in the following countries indicate the tax reference number type and number applicable in each country. Country/countries of tax residency J-TPS-600-F45-Ver1-February 15 2015 Tax reference number type 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 the recipient promptly and provide an updated Self-Certification form within 30 days where any change in circumstances occurs which causes any of the information contained in this form to be inaccurate or incomplete. Where legally obliged to do so I hereby consent to the recipient sharing this information with the TAX ADMINISTRATION JAMAICA TAJ. Signature Date dd/mm/yyyy JAMAICA NATIONAL BUILDING SOCIETY is obliged under the Intergovernmental Agreements IGA entered into by the Jamaica and the United States of America in relation to the automatic exchange of information for tax matters FATCA to collect certain information about each account holder. Please note that in certain circumstances we may be obliged to share this information with TAX ADMINISTRATION JAMAICA TAJ. If any of the information above regarding your tax residence or FATCA classification changes in the future please ensure you advise us of these changes promptly. If you have any questions about your tax status and how it is impacted by the completion of this form please contact your tax advisor. Individual Self-Certification Section 1 Account Holder Identification Account Holder Name Date of Birth dd/mm/yyyy Country of Birth Permanent Residence Address Number Street City/Town State/Province/County Post Code Country Mailing address if different from above Section 2 Declaration of U*S* Citizenship or U*S* Residence for Tax purposes Please tick either a or b or c and complete as appropriate. a I confirm that I am a U*S* citizen and/or resident in the U*S* for tax purposes green card holder or resident under the substantial presence test and my U*S* federal taxpayer identifying number U*S* TIN is as follows surrendered my citizenship as evidenced by the attached documents.

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