Form 8957                    Foreign Account Tax Compliance Act (FATCA) Registration                                       OMB No. 1545-2246
(Rev. June 2017) 
Department of the Treasury   ▶ Go to www.irs.gov/Form8957 for instructions and the latest information.    
Internal Revenue Service 
• All applicants must complete Part 1.
• This form will not be processed if it is not signed.
• DO NOT fill out this form if you have begun registering at http://www.irs.gov/fatca.
• The IRS strongly recommends that applicants register by accessing the online version of this form at http://www.irs.gov/fatca. The 
use of this paper form will take longer for the IRS to process and if any information is missing or incomplete the delay in 
registration may be significant. 
• This form should be mailed to:
     FATCA, Stop 6099 AUSC                                                                                                                                                                             
     3651 South IH 35                                                                                                                                                                                      
     Austin, Texas 78741 

Part 1    Financial Institution Registration 

  1  Select Financial Institution Type (check only one)
       Single (not a member of an Expanded Affiliated Group)
       Lead of an Expanded Affiliated Group
       Member (not Lead) of an Expanded Affiliated Group. If a Member, you must provide the FATCA ID issued for such Member and provided 
       by your Lead:
       Sponsoring Entity 

  2  Legal Name of the Financial Institution 

3 a  What is the Financial Institution's country/jurisdiction of residence for tax purposes? 

  b  What is the Financial Institution's country/jurisdiction tax ID?

  4  Select the Financial Institution's FATCA classification in its country/jurisdiction of tax residence (check only one) 
       Participating Financial Institution not covered by an IGA; or a Reporting Financial Institution under a Model 2 IGA
       Registered Deemed-Compliant Financial Institution (including a Reporting Financial Institution under a Model 1 IGA)
       None of the above

  5  Mailing Address of Financial Institution

     Country/Jurisdiction 

     Address Line 1

     Address Line 2

     City                                                      State/Province/Region                                            ZIP/Postal Code 

For Paperwork Reduction Act Notice, see separate instructions.       Cat. No. 37778V                                      Form  8957 (Rev. 6-2017) 

Form 8957 (Rev. 6-2017)                                                                                                     Page  2 

6  Indicate whether the Financial Institution has in effect a withholding agreement with the IRS to be treated as one of the following:
a  Qualified Intermediary (QI) 
   Provide QI EIN:              -
   Does the Financial Institution intend to maintain its status as a QI?
   Yes
   No

b  Withholding Foreign Partnership (WP) 
   Provide WP EIN:              -
   Does the Financial Institution intend to maintain its status as a WP?
   Yes
   No

c  Withholding Foreign Trust (WT) 
   Provide WT EIN:              -
   Does the Financial Institution intend to maintain its status as a WT? 
   Yes
   No

d  Not applicable

7  Does the Financial Institution maintain a branch in a jurisdiction outside of its country/jurisdiction of tax residence?
   Yes (If “Yes,” complete lines 8 and 9)
   No (If “No,” go to line 10)

8  Is the Financial Institution a tax resident of the United States or does it maintain a branch in the United States (other than the U.S. 
   territories)? 
   Yes  Provide the U.S. EIN of the U.S. Financial Institution or U.S. branch: 
                         -
   No

9  List each jurisdiction (other than the United States) in which the Financial Institution maintains a branch.  Also please list branches 
   maintained in any of the U.S. territories. If none, leave blank and go to line 10. 

   (Use additional sheets to add branches.)

10 FATCA Responsible Officer (RO) for the Financial Institution
   Business Title of RO
   Legal Name
                 Last (Family)             First (Given)                                      Middle 

   City                                                                  Country/Jurisdiction 

   Business Address Line 1

   Business Address Line 2                 State/Province/Region                                                           ZIP/Postal Code

   Business Telephone Number               Business Fax Number                        Business Email Address of RO

                                                                                                                  Form  8957 (Rev. 6-2017) 

Form 8957 (Rev. 6-2017)                                                                                                                           Page  3 

11a The Financial Institution's RO will be a point of contact (POC) for the Financial Institution. In addition, the RO of a Financial Institution 
    registering as a Lead of all or part of an Expanded Affiliated Group will be a POC for each Member of that group. 
    Does the RO or an Authorizing Individual wish to designate one or more additional POCs for the Financial Institution? 
       Yes (If “Yes,” complete line 11b)
       No (If “No,” go to line 12)

b   This line 11b must be completed by the Financial Institution's RO or an Authorizing Individual. Upon entering the POC information 
    below, checking the box that follows, and submitting this registration form, the RO or Authorizing Individual is providing the IRS with 
    written authorization to release FATCA information to the POC. This authorization specifically includes authorization for the POC to 
    complete this Form 8957: FATCA Registration, to take other FATCA-related actions, and to obtain access to the Financial Institution's 
    tax information. 

    Business Title of POC
    Legal Name of POC
                             Last (Family)                     First (Given)                                       Middle 

    City                                                       Country/Jurisdiction 

    Business Address Line 1

    Business Address Line 2                         State/Province/Region                                                       ZIP/Postal Code

    Business Telephone Number              Business Fax Number                      Business Email Address of POC

    Five POCs are allowed per Financial Institution. Use additional sheets to add POCs.

    By checking this box, I,                                         , as RO or Authorizing Individual for the Financial Institution, provide the authorization 
    described above to the identified POCs listed on this line 11b.  Once this authorization is granted, it is effective until revoked by either 
    the Financial Institution or the POC.

Part 2   Expanded Affiliated Group

    Lead Financial Institutions must read the instructions before completing Part 2.
12  Provide the following for each Financial Institution member of the Expanded Affiliated Group

         Legal name of Member Financial Institution            Country/Jurisdiction of residence for tax                  Member type *
                                                                             purposes

* Enter one of the following:
Participating Financial Institution not covered by an IGA; or a Reporting Financial Institution under a Model 2 IGA
Registered Deemed-Compliant Financial Institution (including a Reporting Financial Institution under a Model 1 IGA)
None of the above

                                                                                                                          Form  8957 (Rev. 6-2017) 

Form 8957 (Rev. 6-2017)                                                                                                    Page  4 
Part 2   Expanded Affiliated Group (continued)

13a Is the Financial Institution the Common Parent Entity of the Expanded Affiliated Group?
       Yes (If “Yes,” go to Signature line)
       No (If “No,” complete line 13b)

b   Enter the Legal Name of the Expanded Affiliated Group’s Common Parent Entity. Also enter the FATCA ID (if known).
    Legal Name of the Common Parent Entity  ▶

    FATCA ID  ▶

SIGNATURE

    By checking this box, I,                                           , certify that, to the best of my knowledge, the information submitted above is accurate and 
    complete and I am authorized to agree that the Financial Institution (including its branches, if any) will comply with its FATCA obligations in 
    accordance with the terms and conditions reflected in regulations, intergovernmental agreements, and other administrative guidance to the 
    extent applicable to the Financial Institution based on its status in each jurisdiction in which it operates.
       I declare that I have examined this form including any accompanying statements, and to the best of my knowledge and belief, it is true, correct, and complete. 
Sign   ▲                                      ▲
Here 
          Signature                            Date 
                                                                                                                 Form  8957 (Rev. 6-2017)