1. |
Name of Entity |
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Please indicate the full or short name as constituent documents.
If constitutional documents do not state Latin transcription of the entity name please define and indicate the name using Latin alphabet.
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2. |
Country of incorporation of the entity
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Country of incorporation of the entity
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Please indicate the country of incorporation of the entity
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3. |
Residence address
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Please indicate residence address as stated in constitutional documents.
If constitutional documents do not state Latin transcription of the residence address please define and indicate the address using Latin alphabet.
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4. |
Mailing address |
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Please indicate the mailing address
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5. |
Telephone number(s) and faxes |
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Telephone number(s) and faxes belong/belongs to the US
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Please indicate Telephone number(s) and faxes
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6. |
Main OKVED code and main actual type of activity of the entity (if any)
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Please indicate the code obtained by the entity in accordance with Russian classification of economic activity (OKVED), as well as the main type of activity actually performed by the entity
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7. |
Has the entity obtained
Russian tax identification
number (INN) or code of
foreign organization (KIO)? |
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8. |
Do you have a power of attorney / signature authorization to the person having an address belonging to the US (address of residence or mailing address) |
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9. |
Do you have bank transfer orders for more than one bank transfer to US account or address? |
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10. |
Is the entity a US tax resident? |
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If your answer is “Yes”, please proceed to question 9 and submit W-91 form and indicate your US TIN.
If you selected “No” here but in question 2 and/or 3 provided a US address, and/or a US phone number in question 4, and/or selected “Yes” for question 6, file the Form W-82 and a copy of registration certificate to certify your non-US person status.
If you selected “Yes” here but “No” for question 5, please provide a copy of registration certificate or the Form W8 to certify your non-US person status.
If you selected «No» here but «Yes» for question
8, please provide a copy of registration certificate
or the Form W8 to certify your non-US person
status.
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11. |
Does the entity have a US Taxpayer Identification Number (TIN)? |
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If you selected «Yes», please answer question 12 |
12. |
If the entity is a US tax resident, please specify its residency status (please select one of the options) |
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13. |
Confirmation of tax resident
status of another country
(except for Russia or USA)
and tax identification number
(or equivalent) |
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Is the entity tax resident of another country (different from Russia and the US)?
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Indicate all countries of tax residency and corresponding TINs (or equivalents)
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14. |
Does the entity conduct
financial activities? |
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Entity holds financial assets for the benefit of other persons as a
substantial portion of its business3 ;
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Entity primarily4 conducts one or more of the following activities or operations for or on behalf of a customer:
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Please select all licensed types of activities
If you selected «The entity’s (or structure
established in any form other than a legal entity)
gross income is primarily attributable to investing,
reinvesting, or trading in financial assets and the
entity is managed by another entity which performs
any of the financial activities…» please complete
Annex 4B (Questionnaire for identification of
beneficial owner (controlling person) for every
beneficial owner (controlling person) of the entity
(or structure established in any form other than a
legal entity) and please upload it at the end of this
Questionnaire.
Note that in this case, under FATCA organization
will be treated as financial institution. However,
under CRS the organization may be classified as
both financial institution or passive non-financial
entity (depending on its country of tax residency).
Therefore, please fill in all required fields for both
financial institutions and nonfinancial entities.
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15. |
Is the entity a holding company or treasury center? |
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If you selected in p. 14 «No, the statements mentioned above in present section are not applicable to the entity (or structure established in any form other than a legal entity)» and selected in p. 15 only «Yes, the entity is a holding company or treasury center» without any additional selections, answers to questions 19 and 20 are not required.
If you selected «Yes, the entity is a holding company or treasury center» and selected any additional answer in p.15, answer to question 21 is not required.
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16. |
Does the entity act as an intermediary (works under surety, commission, trust management, agency agreements, or any other civil law agreements for the benefit of a third party(ies))? |
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If you selected “No, the entity is not a financial institution” for question 11 and selected “Yes, the entity acts as an intermediary (works under surety, commission, trust management, agency agreements or any other civil law agreements for the benefit of a third party(ies))” for this question, please complete the Individual/Self-employed Beneficiary Questionnaire for each individual/self-employed beneficiary, and the Questionnaire for identifying an entity for the purposes of FATCA for each beneficiary that is a legal entity, and please upload it at the end of this Questionnaire.
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17. |
Is the entity disregarded for the purposes of FATCA?5 |
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If you selected "Yes, it is a disregarded entity," please complete the Questionnaire for identifying an entity for the purposes of FATCA for your beneficiary/shareholder (the beneficiary/shareholder will be the owner of the account for the purposes of FATCA), and please upload it at the end of this Questionnaire.
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18. |
Does the entity have a Global
Intermediary Identification Number
(GIIN)? |
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If your answer is «Yes» and selected «Yes» for question 14, please answer question 19.
If you selected «No» here and «Yes» for question 14 please answer question 20.
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19. |
If the entity is a financial institution with GIIN or is in the process of registration on the FATCA Portal for obtaining GIIN, please indicate its status for the FATCA purposes (select one of the options) |
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Select the status that you specified during
the registration portal on the IRS |
20. |
If the entity is a financial institution without GIIN and is not in the process of registration on the FATCA Portal for obtaining GIIN, please indicate if the entity has the status of an FFI which does not require registration on the FATCA Portal |
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If you selected “Yes”, please complete Annex1 and submit all Form W8 documents. If you selected “No”, your entity will be classified as a non-participating foreign financial institution (NPFFI).
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21. |
If the entity is a nonfinancial entity, please indicate its status for the CRS purposes (select one of the options) |
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If you selected «Active NFE», please complete Annex 3.
If you selected «Any other entity, that is NOT
included in the list of entities, indicated in Annex 3
(Passive NFE)» please complete Annex 4B
«Beneficial Owner (Controlling Person)
Identification Questionnaire for Individuals» for the
beneficial owner (controlling person) of the entity
(or structure established in any form other than a
legal entity) who directly or indirectly owns more
than 25% of share capital or who exercises control
through other means and please upload it at the
end of this Questionnaire.
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