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EdelweissUpdateFatca

FATCA-CRS ANNEXURE - INDIVIDUALS

(INCLUDING SOLE PROPRIETORS)

(Please consult your professional tax advisor for further guidance on

Details under FATCA / CRS to be filled by each Policyholder/Beneficiary

Are you a tax resident of country other than India?

If 'Yes' please provide the country name

Are you holding citizenship of any other country?

If 'Yes' please provide the country name

Country of Birth

If 'Other' please provide the country name

Are you of Indian Origin?

If 'No' Specify Origin

Country of Current Residence

If 'Other' please provide the country name

Contact details while abroad (other than India)

Type of Address

Telephone No's:

Tax details of other countries (Please indicate all countries in which

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

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

CERTIFICATION

I under penalty of perjury, I certify that:

  • I understand that Edelweiss 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 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 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.
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