152/e/03.17
Client (Contracting Partner):
Client number:
Declaration of AEOI Status and Confirmation of Residence for Tax Purposes
(for controlling persons)
In compliance with the Swiss Federal Act on the International Automatic Exchange of Information in Tax Matters (AEOI Act) and the AEOI
agreements between Switzerland and its partner jurisdictions, Privatbank IHAG Zürich AG (hereinafter referred to as the "Bank") is obliged
to collect information relating to the above Client relationship, in particular information relating to the controlling persons' residence/s for tax
purposes, and to pass it on to the Swiss tax authorities. The Swiss tax authorities then pass all of the information that is relevant under the
AEOI on to the individual tax authorities in reportable jurisdictions. For the purposes of the aforementioned regulations you, as the
undersigned Client, hereby declare and confirm the following information to the Bank.
Please read through the enclosed Glossary before completing this form. It defines key terms, which are given in italics. Neither this document
nor any related written or oral explanations on the part of the Bank constitute tax advice. The Bank recommends contacting a qualified tax
advisor or the relevant tax authorities, if required.
Information about controlling persons is required only if the Account Holder under the AEOI (entity) is a:
•
•
passive NFE under the AEOI; or
a PMIE that is resident in a non-participating jurisdiction for AEOI purposes.
1. Identification of the Account Holder under AEOI and the controlling person (natural person)
Where there are several controlling persons, please complete a separate form for each.
Name of entity (hereinafter referred to as the "Account Holder")
_________________________________________________________________________________________________________________
Surname, first name/s of the controlling person
Residential address (do not use any P.O. Box or c/o addresses)
____________________________________________________
_____________________________________________________
Nationality
____________________________________________________
_____________________________________________________
Date of birth
Postcode, town, and country
____________________________________________________
_____________________________________________________
Place of birth
Country of birth
____________________________________________________
_____________________________________________________
The Account Holder has submitted a completed Form 151, "Declaration of AEOI Status and Confirmation of Residence for Tax Purposes
(for entities)" to declare its status to the Bank. The present declaration intends only to confirm the AEOI status and the
countries/jurisdictions of residence for tax purposes of each of its controlling persons.
2. Countries/jurisdictions of residence for tax purposes and related Tax Identification Number/s (TINs)
Please enter the following information in the table shown below:
•
•
all countries/jurisdictions in which the controlling person is resident for tax purposes; and
the TINs of the controlling person for the jurisdictions listed.
Where a person is resident for tax purposes depends on the tax laws of the jurisdiction in question. An overview of tax residency rules is
provided on the OECD's AEOI portal:
https://www.oecd.org/tax/automatic-exchange/crs-implementation-and-assistance/tax-residency/
Instructions on determining a valid TIN for each participating jurisdiction can be found at:
https://www.oecd.org/tax/automatic-exchange/crs-implementation-and-assistance/tax-identification-numbers/
Country/jurisdiction of residence for tax
purposes
TIN
If no TIN is given, please
state one of the reasons
set out below: A, B, C, D
or E
1
2
3
(If the controlling person is resident for tax purposes in more than three jurisdictions, please continue the list on a separate sheet.)
Privatbank IHAG Zürich AG, Bleicherweg 18, P.O. Box, CH-8022 Zurich, Phone +41 44 205 11 11, Fax +41 44 205 12 85
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152/e/03.17
Client (Contracting Partner):
Client number:
If you or the controlling person are/is unable to provide a TIN for one or more of the jurisdictions listed above, please provide the
corresponding reason A, B, C, D or E in the right-hand column of the table:
Reason A
The country/jurisdiction of residence for tax purposes does not assign TINs to its residents.
Reason B
Residence in this country/jurisdiction is recent and no TIN has yet been assigned, although it has been applied for in the
past 90 days.
Reason C
Although the country/jurisdiction of residence for tax purposes does issue TINs, the controlling person is not obliged to
apply for a TIN.
Reason D
The country/jurisdiction of residence for tax purposes is Switzerland.
Reason E
There are other reasons for being unable to provide a TIN. Please state the reason:
_________________________________________________________________________________________
I/We hereby confirm that the above mentioned controlling person is resident for tax purposes exclusively in those
jurisdictions stated above and listed in any separate sheet attached to this form.
3. Type of controlling person
Please tick the appropriate box to indicate the type of controlling person.
c Controlling person of an entity – control by ownership
c Controlling person of an entity – control by other means
c Controlling person of an entity – senior managing official
c Controlling person of a trust – settlor
c Controlling person of a trust – trustee
c Controlling person of a trust – protector
c Controlling person of a trust – beneficiary
c Controlling person of a trust – other natural person
c Controlling person of another legal arrangement (non-trust)1 – settlor-equivalent
c Controlling person of another legal arrangement (non-trust)1 – trustee-equivalent
c Controlling person of another legal arrangement (non-trust)1 – protector-equivalent
c Controlling person of another legal arrangement (non-trust)1 – beneficiary-equivalent
c Controlling person of another legal arrangement (non-trust)1 – other natural person
4. Change in circumstances
For the duration of the contractual relationship with the Bank, I/we hereby confirm that I/we undertake to notify the Bank independently
and in writing within 30 days if there is a change in the country/jurisdiction of residence for tax purposes and/or the status of the
controlling person with respect to AEOI. Should any confirmation on this form cease to be correct, I/we further agree to submit a new
form and documents within 90 days of such a change in circumstances.
I/We further affirm that I/we am/are aware that the Bank may terminate the above mentioned relationship if, in the event of a change in
circumstances, the above mentioned controlling person fails to comply with his/her obligation to submit the relevant documentation
required to determine the country/jurisdiction in which the controlling person is resident for tax purposes.
1
Other legal arrangements that are not trusts include, for example, foundations or entailed estates.
Privatbank IHAG Zürich AG, Bleicherweg 18, P.O. Box, CH-8022 Zurich, Phone +41 44 205 11 11, Fax +41 44 205 12 85
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152/e/03.17
Client (Contracting Partner):
Client number:
5. Declaration and signature
I/We declare that the controlling person identified on this form has been informed of the content of the form, agrees with the information
given and is aware of the Bank's obligation to supply information to the Swiss tax authorities in accordance with the details given on this
form.
I/We am/are aware that, based on Article 35 of the AEOI Act, wilfully providing incorrect information in a self-disclosure, not notifying the
Bank about any change in circumstances or providing incorrect information about any change in circumstances is subject to penalty.
By signing the form below, I/we confirm that all statements made on this form are, to the best of my/our knowledge and belief correct
and complete.
The Bank reserves the right, having completed a plausibility check, to request a new declaration form.
Place and date:
Signature/s2:
6. Enclosures (please mark as appropriate and enclose the documents concerned)
List expanding point 2 (Country/jurisdiction of residence for tax purposes of controlling person/TIN/Reasons for not stating a TIN)
2
Authorised signatory/ies at the entity, who is/are recorded and identified by the Bank.
Privatbank IHAG Zürich AG, Bleicherweg 18, P.O. Box, CH-8022 Zurich, Phone +41 44 205 11 11, Fax +41 44 205 12 85
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152/e/03.17
7. Glossary
Term
Definition
Account holder under AEOI
The person recorded or identified by the Bank as the holder of the financial account is deemed to be
the Account Holder under AEOI.
If the beneficial owner of the account differs from the Account Holder, the beneficial owner is
deemed to be the Account Holder under AEOI.
A person other than a financial institution holding a financial account for the benefit or account of
another person as an agent, custodian, nominee, signatory, investment advisor or intermediary is not
treated as the Account Holder under AEOI. Rather, this other person is deemed to be the Account
Holder.
In the case of a banking relationship with trusts, the trust itself, and not the trustee, is deemed to be
the Account Holder under AEOI.
Controlling person
Natural persons who exercise control over an entity. In the case of a trust, this term refers to the
settlor/s, trustee/s, the protector/s (if any), the beneficiary/ies or class/es of beneficiaries, and any other
natural person/s exercising ultimate effective control over the trust. In the case of a legal arrangement
other than a trust, but similar to a trust, this term refers to persons in equivalent or similar positions.
The term "controlling person" must be interpreted in a manner consistent with the Swiss
implementation of the Financial Action Task Force (FATF) recommendations, i.e. for banking
relationships in Switzerland the Agreement on the Swiss Banks' Code of Conduct with Regard to the
Exercise of Due Diligence (CDB 16).
Country/jurisdiction of
residence for tax purposes
Generally, a natural person is resident for tax purposes in a country/jurisdiction if, under the laws of
that country/jurisdiction (including international tax treaties), he/she pays or should be paying tax
therein by reason of his/her domicile, residence or any other criterion of a similar nature (i.e. full tax
liability), and not only on the basis of income from sources within this country/jurisdiction. Persons
who are resident in several states may rely (where applicable) on the tiebreaker rules contained in the
applicable double taxation treaties to determine their residence for tax purposes.
For the purposes of this form, the term "countries/jurisdictions" covers all legal forms relevant in
connection with tax residence, specifically countries, territories and jurisdictions.
Entity
The term "entity" refers to a legal entity or a legal agreement such as a corporation, a partnership, a
trust or a foundation.
NFE (Non-Financial Entity)
An NFE is any entity which is not a financial institution. An NFE may be either Passive or Active NFE.
Participating
country/jurisdiction vs. nonparticipating
country/jurisdiction
The term "participating country/jurisdiction" refers to a country or jurisdiction (i) with which
Switzerland has agreed the automatic exchange of information, or (ii) which is identified in the
following list: www.oecd.org/tax/transparency/AEOI-commitments.pdf
Passive NFE
The term "Passive NFE" refers to any NFE that is not an Active NFE, and any professionally managed
investment entity that is not resident in a participating jurisdiction.
Professionally managed
investment entity (PMIE)
An entity which is managed by another entity which is a financial institution.
The term "non-participating country/jurisdiction" covers all countries and jurisdictions which do not
fulfil the aforementioned conditions.
The entity is deemed to be professionally managed if financial assets are managed on the basis of
discretionary decision-making powers wholly or partly by a financial institution (such as a bank or
asset manager), but not by a natural person.
If the entity is classified at another financial institution as a professionally managed investment entity
(e.g. owing to an asset management mandate), then the entity is also deemed to be a PMIE in the case
of dealings with any other financial institution.
Reportable account
The term "reportable account" refers to an account held by one or more reportable persons or
controlling persons, provided it has been identified as such pursuant to the due diligence procedures
described in the agreement on the automatic exchange of information.
Reportable jurisdiction
The term "reportable jurisdiction" refers to a country/jurisdiction with which Switzerland has concluded
an agreement on the automatic exchange of information. A list of countries/jurisdictions with which
Switzerland has concluded such an agreement can be viewed at:
https://www.sif.admin.ch/sif/en/home/themen/internationale-steuerpolitik/automatischerinformationsaustausch.html
Privatbank IHAG Zürich AG, Bleicherweg 18, P.O. Box, CH-8022 Zurich, Phone +41 44 205 11 11, Fax +41 44 205 12 85
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152/e/03.17
Term
Definition
Reportable person
With the following exceptions, the term "reportable person" refers to a person from a reportable
jurisdiction:
a) a corporation, the shares of which are traded regularly on one or more established securities
exchanges,
b) a corporation which constitutes an entity related to a stock corporation described under a),
c) a governmental entity,
d) an international organisation,
e) a central bank, or
f) a financial institution
TIN (Tax Identification
Number)
The term "TIN" refers to a Tax Identification Number or a functional equivalent in the absence of a
TIN. A TIN is a unique combination of letters or numbers assigned by the jurisdiction of residence to
identify natural persons and entities for tax purposes. Further details of acceptable TINs can be found
on the OECD AEOI portal at: https://www.oecd.org/tax/automatic-exchange/crs-implementation-andassistance/tax-identification-numbers/
Privatbank IHAG Zürich AG, Bleicherweg 18, P.O. Box, CH-8022 Zurich, Phone +41 44 205 11 11, Fax +41 44 205 12 85
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