FATCA/CRS/DAC II Financial Institution Registration Form

Income Tax Reg No  
Data Provider No: Click for Help       
Type of Entity:    
Other      

Types of Financial Accounts Maintained (please tick as appropriate)  

Depository Accounts  
Custodial Accounts  
Cash Value Insurance Contracts  
Annuity Contracts  
Equity and Debt Interest  

Reporting / Non-Reporting FI (Financial Institution)

FATCA   Effective Reporting Year  
Reason  
CRS/DACII   Effective Reporting Year  
Reason  

Please indicate whether an election is being made in relation to the relevant thresholds as per the following Sections in Annex I of the Malta-US IGA (please tick as appropriate)

Effective Reporting Year  
For the purpose of Section II.A.  
For the purpose of Section III.A.  
For the purpose of Section IV.A.  
For the purpose of Section V.A.  
Please describe extent of the election  
GIIN Number  

Please indicate whether an election/option is being made in relation to the relevant provisions as per the following Sections in Annex I of the Cooperation with Other Jurisdiction on Tax Matters Regulations (please tick as appropriate)  

Effective Reporting Year  
For the purpose of Section II.D.  
For the purpose of Section II.E.  
For the purpose of Section V.A.  
Please describe extent of the election  

Type of Financial Institution (please tick as appropriate)  

FATCA CRS
Custodial Institution  
Depository Institution
Investment Entity  
Specified Insurance Company  

Financial Institution Contact Person/s

FATCA CRS Override CRS Details
Name
Designation
Building Name/No
Street
Locality
Post Code    
Country
Tel/Mob No
Email    

Security Code reset
Security Code

Financial Institution Director/Trustee/Administrator Details

Name
ID Card/Passport No
Tel/Mob No
Email  
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