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In accordance with existing regulations investors are required to confirm certain information regarding their tax status. This is in accordance with agreements made between the UK, the Crown Dependencies and Overseas Territories, the US (where relevant under the Foreign Account Tax Compliance Act - FATCA) and over 90 other countries around the world. These agreements are collectively known as the Automatic Exchange of Information (AEOI). The overriding aim of the AEOI is to ensure that financial institutions like Redmayne Bentley identify and report persons or entities with whom they have a fiduciary relationship and who are tax resident in any participating country.
The information you provide in this form will help us ensure that you receive correct tax treatment. Please answer all the following questions as accurately as possible. Should you not wish to share the necessary information with Redmayne Bentley then this will impede our ability to fulfil our reporting obligations and may result in you receiving unfair tax treatment and/or your account activity being reported to tax revenue agencies unnecessarily. In some instances, it may be necessary for Redmayne Bentley to limit the service we are able to provide to you until this information is confirmed. For assistance completing the form, please see our Guidance Notes.

1. PERSONAL DETAILS

Title
Surname
First Name(s) (In full)
Telephone
Redmayne Bentley Account Number(s)

2. CURRENT RESIDENTIAL ADDRESS

Residential Address
Town
Country
Postal Code/ZIP Code (if any)

3. MAILING ADDRESS (if different from the current residential address)

Mailing Address
Town
Country
Postal Code/ZIP Code (if any)

4. DATE OF BIRTH (dd/mm/yyyy)

5. PLACE OF BIRTH

Town/City of Birth
Country of Birth

6. COUNTRY(ies) OF TAX RESIDENCY

Please complete the following table indicating (1) where the Account Holder is resident for tax purposes and (2) the Account Holder’s Taxpayer Identification Number (TIN). If the Account Holder fulfils residency requirements in more than one country, please provide details of all countries of residence for tax purposes. Please see the guidance notes for further information.

Country(ies) of Tax Residency
Tax Identifcation Number
1.
2.
3.
4.

7. DECLARATION AND SIGNATURE

I acknowledge that the information contained in this form may be provided to HMRC and exchanged with the local authority in my primary country of residency for tax purposes.

I certify that I am the Account Holder (or I am authorised to sign for the Account Holder) of all the accounts to which this form relates.

I have read and understood this form and the supporting documents. Where necessary I have referred to guidance issued by my local tax authority and/or sought advice from a suitably qualified tax advisor.

I declare that, to the best of my knowledge, all information provided in this document is correct and complete. I undertake to inform Redmayne Bentley within 30 days of any change in circumstances that might invalidate any of information provided.

Signature
Print name
Date (dd/mm/yyyy)

Note: If you are not the Account Holder please indicate the capacity in which you are signing the form (e.g. Power of Attorney (POA)*)

Capacity

*If you are completing this form in a POA capacity please send a copy of the relevant POA document or equivalent to the following address: Regulatory Reporting, Redmayne Bentley LLP, 3 Wellington Place, Leeds, LS1 4AP, United Kingdom.

If you do not wish to complete this Tax Residency: Self-Certification Form online, you may provide this information to us by telephone to your usual Redmayne Bentley office or account executive.