1.
Name of Entity
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.
2.
Country of incorporation of the entity
Country of incorporation of the entity
Russian Federation
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia, Plurinational State of
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (the Democratic Republic of the)
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands [Malvinas]
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia (The)
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See [Vatican City State]
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (the Islamic Republic of)
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (the Democratic People's Republic of)
Korea (the Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia (the former Yugoslav Republic of)
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (the Federated States of)
Moldova (the Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Rwanda
Saint Barthelemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan (Province of China)
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela, Bolivarian Republic of
Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara*
Yemen
Zambia
Zimbabwe
Please indicate the country of incorporation of the entity
3.
Residence address
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.
4.
Mailing address
Please indicate the mailing address
5.
Telephone number(s) and faxes
Telephone number(s) and faxes belong/belongs to the US
Please indicate Telephone number(s) and faxes
6.
Main OKVED code and main actual type of activity of the entity (if any)
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
7.
Has the entity obtained
Russian tax identification
number (INN) or code of
foreign organization (KIO)?
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)
9.
Do you have bank transfer orders for more than one bank transfer to US account or address?
10.
Is the entity a US tax resident?
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.
11.
Does the entity have a US Taxpayer Identification Number (TIN)?
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)
13.
Confirmation of tax resident
status of another country
(except for Russia or USA)
and tax identification number
(or equivalent)
Is the entity tax resident of another country (different from Russia and the US)?
Indicate all countries of tax residency and corresponding TINs (or equivalents)
14.
Does the entity conduct
financial activities?
Yes. Please indicate the type of the financial activity:
Entity holds financial assets for the benefit of other persons as a
substantial portion of its business3 ;
Entity accepts investments of funds (e.g. deposits) in the ordinary course of a banking or similar business;
Entity primarily4 conducts one or more of the following activities or operations for or on behalf of a customer:
Entity is an insurance company (or the holding company of an insurance company) that issues, or is obligated to make payments with respect to a cash value insurance or annuity contract;
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 mentioned above;
The entity’s (or structure established in any form other than a legal entity)
functions or holds itself out as a collective investment vehicle, mutual fund,
exchange traded fund, private equity fund, hedge fund, venture capital fund,
leveraged buyout fund, or any similar investment vehicle established with an
investment strategy of investing, reinvesting or trading in financial assets
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.
15.
Is the entity a holding company or treasury center?
Yes, the entity is a holding company5 or treasury center6. In addition to this (to beindicated if applicable):
The entity is a part of an expanded affiliated group7(or is considered as related entity) which includes a financial institution that accepts deposits in the ordinary course of a banking or similar business, or holds financial assets for the benefit of other persons as a substantial portion of its business, or that issues, or is obligated to make payments with respect to a cash value insurance or annuity contract or that performs an investment activity indicated in p. 14; The entity is formed in connection with or availed of by, functions as or hold itself out as collective investment vehicle, mutual fund, exchange traded fund, private equity fund, hedge fund, venture capital fund, leveraged buyout fund, or any similar investment vehicle established with an investment strategy of investing, reinvesting or trading in financial assets.
No.
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.
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))?
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.
17.
Is the entity disregarded for the purposes of FATCA?5
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.
18.
Does the entity have a Global
Intermediary Identification Number
(GIIN)?
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.
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)
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
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).
21.
If the entity is a nonfinancial entity, please indicate its status for the CRS purposes (select one of the options)
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.