Country/Jurisdiction of Tax Residence and related Taxpayer Identification Number or equivalent number (“TIN”)

Please complete the following table indicating (i) where the Account Holder is tax resident; and (ii) the Account Holder’s TIN for each country/jurisdiction indicated.

Country/Jurisdiction of Tax Residence and related Taxpayer Identification Number or equivalent number (“TIN”)

Please complete the following table indicating (i) where the Account Holder is tax resident; and (ii) the Account Holder’s TIN for each country/jurisdiction indicated.

Country/Jurisdiction of Tax Residence and related Taxpayer Identification Number or equivalent number (“TIN”)

Please complete the following table indicating (i) where the Account Holder is tax resident; and (ii) the Account Holder’s TIN for each country/jurisdiction indicated.

Please complete the following table with your tax residency details

Country/Jurisdiction of tax residence

1

This field is mandatory.

TIN

This field is mandatory.

If no TIN available, enter Reason A, B or C

Reason A Reason B Reason C
This field is mandatory.

2

This field is mandatory.
This field is mandatory.
Reason A Reason B Reason C
This field is mandatory.

3

This field is mandatory.
This field is mandatory.
Reason A Reason B Reason C
This field is mandatory.

4

This field is mandatory.
This field is mandatory.
Reason A Reason B Reason C
This field is mandatory.

5

This field is mandatory.
This field is mandatory.
Reason A Reason B Reason C
This field is mandatory.

Reason A - The country/jurisdiction where the Account Holder is a tax resident does not issue TINs to its tax residents

Reason B - The Account Holder is otherwise unable to obtain a TIN or equivalent number

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 the TIN issued by such jurisdiction)

Please explain in the following boxes the reason you are unable to obtain a TIN if you selected Reason B above.

1

This field is mandatory.

2

This field is mandatory.

3

This field is mandatory.

4

This field is mandatory.

5

This field is mandatory.