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Page 5 of 7 Fileid: … ns/I8957/201706/A/XML/Cycle03/source 15:10 - 18-May-2017
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
control). If the FI is a dual resident, identify Line 6. Check the appropriate box to “establish the statuses” for purposes of
one of the countries where it is a tax indicate that the FI is a party to a QI, WP, this line 10, an RO must have the authority
resident on this line and identify the or WT Agreement with the IRS and to act on behalf of the FI to represent the
second jurisdiction of tax residence on provide the EIN that was issued to the FI FATCA status(es) of the FI to the IRS as
line 8 (if the second jurisdiction is the for use in identifying itself when acting in part of the registration process. The RO
United States) or line 9 (if the second tax its capacity as a QI, WP, or WT. If the FI for purposes of this line must also have
residence jurisdiction is a country other enters into a QI, WP, or WT agreement the authority under local law to designate
than the United States). after it submits this registration form, the FI additional POCs. The individual identified
Partnerships and other flowthrough should amend its response to this as the RO on this line 10 will be the only
entities. For a partnership or other question to reflect its new status as a QI, individual who will receive emails from the
flow-through entity, the FI’s jurisdiction of WP, or WT and add its EIN to its IRS related to the FI's FATCA account.
residence means the jurisdiction under the registration. This is done by editing the The meaning of “authority to act on
laws of which the entity is organized or FI's online FATCA account. For more behalf of the FI to represent its FATCA
established or, if not organized or information, see Paper registration on status” is determined based on the FI's
established under the laws of any page 1. Check “Yes” or “No” to indicate status, as follows.
jurisdiction, the jurisdiction where it whether the FI intends to maintain its With respect to a PFFI, an RO is an
maintains its principal office. status as a QI, WP, or WT. officer of the FFI (or an officer of any
Line 3b. Enter the FI's country/jurisdiction Check “Not Applicable” if the FI is not a Member FI that is a PFFI, Reporting FI
tax ID. Some countries/jurisdictions may party to a QI, WP, or WT Agreement with under a Model 1 IGA, or Reporting FI
use a Tax Identification Number ("TIN") to the IRS. under a Model 2 IGA) with authority to
fulfill the duties of a Responsible Officer
identify taxpayers. If the FI is in a Line 7. Check “Yes” if the FI maintains a described in an FFI Agreement.
jurisdiction that uses TINs and the FI has a branch outside its jurisdiction of tax With respect to a PFFI that elects to be
TIN, enter its TIN on this line. If the FI does residence. A branch is a unit, business, or part of a consolidated compliance
not have a TIN, leave this line blank. office of an FI that is treated as a branch program, an RO is an officer of the
Line 4. Check the box applicable to your under the regulatory regime of a Compliance FI with authority to fulfill the
FATCA classification in your jurisdiction of jurisdiction or is otherwise regulated under duties of a Responsible Officer described
tax residence. Only one box may be the laws of a jurisdiction as separate from in the FFI Agreement on behalf of each
checked. other offices, units, or branches of the FI. FFI in the compliance group (regardless of
FIs should treat all offices or business whether the FFI is treated as a Reporting
A Sponsoring Entity, Direct Reporting units within any one jurisdiction as a single FI under a Model 1 IGA or Reporting FI
NFFE, trustee of a Trustee-Documented branch. under a Model 2 IGA).
Trust, a USFI registering as a Lead FI, a
U.S. Territory FI, or a USFI with a foreign Sponsoring Entities, Trustees of With respect to a RDCFFI, other than
branch that intends to apply for status as a Trustee-Documented Trusts, and an RDCFFI that is a Reporting FI under a
QI and is required to obtain a GIIN as a Direct Reporting NFFEs. If you are Model 1 IGA, an RO is an officer of the FI
condition of such status or that is treated applying as a Sponsoring Entity, trustee of (or an officer of any Member FFI that is a
as a Reporting FI under a Model 1 IGA a Trustee-Documented Trust, or Direct PFFI, Reporting FI under a Model 1 IGA,
must select “None of the Above.” Reporting NFFE, you do not need to or Reporting FI under a Model 2 IGA) with
answer questions about your branches authority to ensure that the FFI meets the
A disregarded entity that is registering and should check “No.” applicable requirements to be treated as
separate from its owner in order to be a an RDCFFI.
Reporting FI under a Model 1 IGA should Line 8. Check “Yes” if the FI is either a With respect to a Reporting FI under a
select RDCFFI. U.S. resident or maintains a branch within Model 1 IGA, an RO is any individual
the United States, and provide the EIN of specified under local law to register and
Note: FIs with branches in multiple ju the FI or U.S. branch, as appropriate. obtain a GIIN on behalf of the FFI. If,
risdictions. An FI (other than a
Sponsoring Entity, USFI, or foreign branch Line 9. Separately identify each however, the Reporting FI under a Model
of a USFI) that maintains branch jurisdiction where the FI maintains a 1 IGA operates any branches outside of a
operations in multiple jurisdictions should branch outside of the United States, Model 1 IGA jurisdiction, then the RO
answer this question by treating the including if the FI maintains a branch in a identified must be an individual who can
operations within its country of tax U.S. Territory, other than jurisdictions satisfy the requirements under the laws of
residence as if it were a branch (home where the FI maintains related branches. the Model 1 IGA jurisdiction and the
office) and then classify whether such Use additional sheets to furnish the requirements relevant to the registration
home office is participating or registered required information for each separate type selected for each of its non-Model 1
deemed compliant. On line 9 of the jurisdiction in which the FI maintains a IGA branches.
registration form, the FI should identify the branch. With respect to a USFI that is
jurisdictions (other than the United States) When a disregarded entity is required registering as a Lead FI, an RO is any
where it maintains branches outside of its to register on its own behalf, discussed officer of the FI (or an officer of any
jurisdiction of tax residence, other than earlier, its owner should not report the Member FI) with authority to register its
jurisdictions where the FI maintains disregarded entity as a branch on this Member FIs and to manage the online
related branches. If the FI maintains line 9. FATCA accounts for such members.
branches in the United States, the FI With respect to a Direct Reporting
should enter this information on line 8. Line 10. Provide the name, title, address, NFFE, an RO is the individual who will be
and contact information of the responsible for ensuring that the Direct
Line 5. Enter the mailing address of the Responsible Officer (RO) of the FI. For Reporting NFFE meets its reporting
FI. The address provided will be used to purposes of line 10, RO means the person obligations as a Direct Reporting NFFE
send all mail correspondence related to authorized under applicable local law to and will act as a POC with the IRS in
the FI's FATCA registration, FATCA establish the statuses of the FI's home connection with its status as a Direct
account, and any other related matters. office and branches as indicated on the Reporting NFFE.
registration form. To have the authority to
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