COMMON REPORTING STANDARDS (CRS) Instruc ons · COMMON REPORTING STANDARDS (CRS) Instruc ons Please read these instructions before completing the form What? To help protect the integrity

Malacca Securi�es Sdn Bhd(16121-H)(A Par�cipa�ng Organisa�on Of Bursa Malaysia Securi�es Berhad)

CRS Tax-Residency Self Cer�fica�on form Individual

COMMON REPORTING STANDARDS (CRS)Instruc�onsPlease read these instructions before completing the form

What?To help protect the integrity of tax systems, governments around the world are implementing a new information gathering and reporting requirement for financial institutions. This is known as the Common Reporting Standard. (‘the CRS’).

Under the CRS, Financial Institutions are require to report financial accounts held, directly or indirectly, by account holders that are tax residents in a CRS jurisdiction, a country that agreed to implement the CRS.

Completing this form will ensure that we hold accurate and up to date information about your tax residency.

If your circumstances change and any of the information provided in this form becomes incorrect, please let us know immediately and provide an updated Self-Certification form.

Who?

Individual account holder including a sole proprietor should complete this form.

If you need to self-certify on behalf of an entity(which includes businesses or partnership), complete an ‘Entity Tax Residency Self-Certification Form’(CRS-E). Similarly, if you are a controlling person of an entity, complete a ‘Controlling Person Tax Residency Self-Certification Form’(CRS-CP).

If you are completing this form on behalf of someone else, please ensure that you let them know that you have done so and tell us in what capacity you are signing in Part 3. For example, you might be completing this form as a custodian or nominees of an account or under a Power of Attorney.

How?

As a financial institution, we are not allowed to give tax advice.

Your tax adviser may be able to assist you in answering specific questions on this form. Your domestic tax authority can provide guidance regarding how to determine your tax status.

You can also find out more, including a list of countries that have signed agreements to automatically exchange information, and local tax laws along with details about the information being requested on the OECD automatic exchange of information portal.

Please complete Parts 1-3 in BLOCK CAPITALS



Part 1 Identification of Individual Account Holder

A. Name of Account HolderFamily Name or Surname

Title

First or Given Name

Middle Name

Mr Mrs Ms Others

B. Permanent AddressLine 1(House/Apt/ Suite Number, Street)

Line 2(Town/City/Province/Country/State)

Country Postal / Zip Code

C. Mailing AddressLine 1(House/Apt/ Suite Number, Street)

Line 2(Town/City/Province/Country/State)

Country Postal / Zip Code

D. Date of Birth

E. Place of BirthTown / City of Birth

Country of Birth

D D M M Y Y Y Y

Part 2



Country of Residence for Tax Purposes and related Taxpayer Identification Number or functional equivalent (“TIN”) (Refer to Appendix)

Please comple�ng the following table indica�ng:

If a TIN is unavailable, please provide the appropriate reason A, B or C:

(i) where the Account Holder is a tax resident;(ii) the Account Holder’s TIN for each country indicated.

If the Account Holder is tax resident in more than three countries, please use a separate sheet

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

Reason A The country where the Account Holder is liable to pay tax does not issue TINs to its residents.

Reason B

Reason C

The Account Holder is otherwise unable to obtain a TIN or equivalent number (Please explain why you are unable to obtain a TIN in the below table if you have selected reason)

No TIN is required. (Note: Only select this reason if the authorities of the country of tax resident entered below do not require the TIN to be disclosed)

1

2

3

Country of Tax Residence TIN If no TIN available, enterReason A, B or C

1

2

3

Part 3 Declaration and Signature



I understand that the informa�on supplied by me is covered by the full provisions of the terms and condi�ons governing the Account Holder’s rela�onship with Malacca Securi�es Sdn Bhd (MSSB) se�ng out how MSSB may use and share the informa�on supplied by me.

I acknowledge that the informa�on contained in this form and informa�on regarding the Account Holder and any Reportable Account(s) may be provided to the tax authori�es of the country in which this account(s) is/are maintained and exchanged with tax authori�es of another country or countries in which the Account Holder may be tax resident pursuant to intergovernmental agreements to exchange financial account informa�on.

I cer�fy that I am the Account Holder (or am authorized to sign for the Account Holder) of all the account(s) to which this form relates.

I cer�fy that where I have provided informa�on regarding any other person (such as a Controlling Person or other Reportable Person to which this form relates) that I will, within 30 days of signing this form, no�fy those persons that I have provided such informa�on to MSSB and that such informa�on may be provided to the tax authori�es of the country in which the account(s) is/are maintained and exchanged with tax authori�es of another country or countries in which the person may be tax resident pursuant to intergovernmental agreements to exchange financial account informa�on.

I declare that all statements made in this declara�on are, to the best of my knowledge and belief, correct and complete.

I undertake to advise MSSB within 30 days of any change in circumstances which affects the tax residency status of the individual iden�fied in Part 1 of this form or causes the informa�on contained herein to become incorrect, and to provide MSSB with a suitably updated Self-cer�fica�on and Declara�on within 90 days of such change in circumstances.

SUBSCRIBED AND SOLEMNLY

Print Name

declared by the account holder

Signature of account holder:

Date :Note:If you not the Account Holder, please indicate the capacity in which you are signing the form. If signing under a power of a�orney, please do a�ach a cer�fied copy of the power of a�orney.

Capacity:

Appendix Definition



Note: These are selected defini�ons provided to assist you with the comple�on of this form. Further details can be found within the OECD Common Repor�ng Standard for Automa�c Exchange of Financial Account Informa�on (‘the CRS’), the associated Commentary to the CRS, and domes�c guidance. This can be found at the following link:h�p://www.oecd.org/tax/transparency/automa�cexchangeofinforma�on.htm

If you have any ques�ons then please contact your tax adviser or domes�c tax authority.

‘Account Holder’ The term ‘Account Holder’ means the person listed or iden�fied as the holder of a Financial Account. A person, other than a Financial Ins�tu�on, holding a Financial Account for the benefit of another person as an agent, a custodian, a nominee, a signatory, an investment advisor, an intermediary, or as a legal guardian, is not treated as the Account Holder. In these circumstances that other person is the Account Holder. For example in the case of a parent/child rela�onship where the parent is ac�ng as a legal guardian, the child is regarded as the Account Holder. With respect to a jointly held account, each joint holder is treated as an Account Holder.

‘Controlling Person’ This is a natural person who exercises control over an en�ty. Where an en�ty Account Holder is treated as a Passive Non-Financial En�ty (‘NFE’) then a Financial Ins�tu�on must determine whether such Controlling Persons are Reportable Persons. This defini�on corresponds to the term ‘beneficial owner’ as described in Recommenda�on 10 of the Financial Ac�on Task Force Recommenda�ons (as adopted in February 2012). If the account is maintained for an en�ty of which the individual is a Controlling Person, then the ‘Controlling Person tax residency Self-Cer�fica�on’ form should be completed instead of this form.

‘En�ty’ The term ‘En�ty’ means a legal person or a legal arrangement, such as a corpora�on, organisa�on, partnership, trust or founda�on.

‘Financial Account’ A Financial Account is an account maintained by a Financial Ins�tu�on and includes: Depository Accounts; Custodial Accounts; Equity and debt interest in certain Investment En��es; Cash Value Insurance Contracts; and Annuity Contracts.

‘Par�cipa�ng Jurisdic�on’ A Par�cipa�ng Jurisdic�on means a jurisdic�on with which an agreement is in place pursuant to which it will provide the informa�on required on the automa�c exchange of financial account informa�on set out in the Common Repor�ng Standard.

‘Reportable Account’ The term ‘Reportable Account’ means an account held by one or more Reportable Persons or by a Passive NFE with one or more Controlling Persons that is a Reportable Person.

‘Reportable Jurisdic�on’ A Reportable Jurisdic�on is a jurisdic�on with which an obliga�on to provide financial account informa�on is in place.

‘Reportable Person’ A Reportable Person is defined as an individual who is tax resident in a Reportable Jurisdic�on under the tax laws of that jurisdic�on. Dual resident individuals may rely on the �ebreaker rules contained in tax conven�ons (if applicable) to solve cases of double residence for purposes of determining their residence for tax purposes.

‘TIN’ (including ‘func�onal equivalent’) The term ‘TIN’ means Taxpayer Iden�fica�on Number or a func�onal equivalent in the absence of a TIN. A TIN is a unique combina�on of le�ers or numbers assigned by a jurisdic�on to an individual or an En�ty and used to iden�fy the individual or En�ty for the purposes of administering the tax laws of such jurisdic�on.

Further details of acceptable TINs can be found at the following link:h�p://www.oecd.org/tax/transparency/automa�cexchangeofinforma�on.htm

Some jurisdic�ons do not issue a TIN. However, these jurisdic�ons o�en u�lise some other high integrity number with an equivalent level of iden�fica�on (a ‘func�onal equivalent’). Examples of that type of number include, for individuals, a social security/insurance number, ci�zen/personal iden�fica�on/service code/number, and resident registra�on number.

Documents

COMMON REPORTING STANDARDS (CRS) Instruc ons · COMMON REPORTING STANDARDS (CRS) Instruc ons Please read these instructions before completing the form What? To help protect the integrity