EFTA01478182.pdf

Guidance to the Entity Self-Certification Form This guidance document provides assistance with completing this Self- Certification. Section A: How to complete the form Part 1A Entity account holder Part 1A is required for every Self-Certification form. Field 1 Legal Name of Entity: Guidance Enter the full legal name of the Entity for which you are completing this form. This should be the full name of the entity or organization that is the account holder, including any particular designation or wording necessary to identify the Entity. For corporate entities, this would usually be the full name of the corporate entity. 2 Country of Incorporation or Organization: If the Entity Account Holder is a: — Corporation—enter the name of the country (and the province, state or other sub-national division where relevant under national law) of incorporation. — Branch—enter the name of the country where your branch"s principal place of business is located. — Another type of entity—enter the name of the country (and province, state or other sub-national entity where relevant) under whose laws it is created, organized or governed. Part 1B Entity tax residency Part 1B is required for every Self-Certification form. Field Guidance Entity"s Country (Countries) of Tax Residence Enter the name of the country (countries) where the Entity or Organization is resident for tax purposes. Part 2 Declaration and signature If the Entity Account Holder is tax resident in any location other than the United States, Part 2 must be completed and signed. Part 2 does not need to be completed or signed for an Entity Account Holder whose sole tax residency is the United States. Please read statements 1-3 and confirm that the statements are, to the best of your knowledge and belief, correct and complete. Then please read the declaration and complete the signature section. Signor must be authorized to sign on behalf of the entity and must indicate the capacity in which he or she is signing the form (e.g. Trustee, Corporate/Individual Director, etc.). WM167720 023743.041516 Page 1 of 5 EFTA01478182 Section B: How to complete Appendix 1 Appendix 1: Controlling persons The person completing the form should complete this Appendix for each person who is a "Controlling Person" of the Entity, but only if the Entity has a tax residence outside the United States. Who are Controlling Persons? The term "Controlling Persons" means the natural persons who exercise control over the Entity. This will vary between jurisdictions and different types of entity but for the purposes of completing the Self-Certification it is based on the AntiMoney Laundering (AML) and Know Your Client (KYC) requirements applicable to Deutsche Bank Wealth Management Americas. You will previously have provided AML and KYC information for the Accounts when they were opened and when the records of Deutsche Bank Wealth Management Americas were updated. If you wish to receive further guidance on this, please contact your Relationship Manager. By way of example, in the case of a trust, such term means the settlor, the trustees, the protector (if any), the beneficiaries or class of beneficiaries, and any other natural person exercising ultimate effective control over the trust. For a corporate vehicle, such term means the directors or officers of the entity as well as the natural person(s) who directly or indirectly holds 25% or more of the capital, shares or controls 25% or greater of the voting rights. For other types of legal entity, please consider the way in which it is operated and who exercises decision making powers in respect of it. The Controlling Persons will include natural person(s) who exercises control over 25% or greater of the property of an entity and any natural person(s) who otherwise directly or indirectly exercises a controlling influence on the management of assets or property or the distribution of income. continued on next page WM167720 023743.041516 Page 2 of 5 EFTA01478183 Appendix 1: Controlling persons (continued) How to complete this Appendix For each Controlling Person identified, please complete their details in the boxes provided. Please continue on a separate sheet if necessa ry and attach the sheet to the form and appendices. Field Guidance First Name Last Name Date of Birth Controlling Person Type/Role Enter the full first name of the individual who is a Controlling Person Enter the last name of the individual who is a Controlling Person Enter the Controlling Person"s date of birth including the year Please enter the type of Controlling Person and their role based on the below indicative list: a. Controlling Person of a legal entity—control by ownership b. Controlling Person of a legal entity—control by other means c. Controlling Person of a legal entity—senior managing official d. Controlling Person of a trust—settlor/grantor e. Controlling Person of a trust—trustee f. Controlling Person of a trust—protector g. Controlling Person of a trust—beneficiary h. Controlling Person of a trust—other i. Controlling Person of a legal arrangement (non-trust)—settlor-equivalent j. Controlling Person of a legal arrangement (non-trust)—trustee-equivalent k. Controlling Person of a legal arrangement (non-trust)—protector-equivalent 1. Controlling Person of a legal arrangement (non-trust)—beneficiary- equivalent m. Controlling Person of a legal arrangement (non-trust)—other Country/Countries of Tax Residence: Enter the names of all countries in which the Controlling Person is a tax resident. Is Controlling Person a non-US Beneficiary/non-US Beneficial Owner? If the Controlling Person is also a non-US Beneficiary/non-US Beneficial Owner, check the flYes" box. If not, check the ”No" box. See Section C: How to Complete Appendix 2 for definitions of Beneficiary and Beneficial Owner If you have checked the ”Yes" box, Appendix 2 must be completed and signed by that Controlling Person. WM167720 023743.041516 Page 3 of 5 EFTA01478184 Section C: How to complete Appendix 2 Appendix 2: Non-US beneficiary/Non-US beneficial owner self-certification This Appendix should be completed and signed by non-US Beneficiaries and non - US Beneficial Owners of the entity: If entity is an operating company/entity or a public entity (e.g., fund, charity, public corporation), the Appendix should be completed and signed only by all non-US Beneficiaries/non-US Beneficial Owners of the entity whose ownership interest is 25% or greater. If entity is a Private Investment Company, Appendix 2 must be completed and signed by all non-US Beneficial Owners of the entity. You are a non-US Beneficiary or a non-US Beneficial Owner if you are a Beneficiary or Beneficial Owner and have a tax residence outside of the United States. Who is a Beneficiary? A Beneficiary of an account is one who is entitled to the income or capital for tax purposes and has the benefit thereof, taking into account the economic, legal, factual and other relevant circumstances under which the income is received. It does not mean a person who receives income as an agent, nominee or mere conduit for another person. Who is a Beneficial Owner? A Beneficial Owner is an individual or an entity who holds (directly or indirectly), any ownership interest in an entity or can control the composition of the Board of Directors of an entity. In the case of a Revocable Trust, the Grantor/Settlor would be considered the Beneficial Owner. What is a Private Investment Company (PIC)? PICs are non-US financial vehicles established to hold and administer assets of one or more underlying beneficial owner(s), while not engaging in any ongoing business activity (e.g. the entity does not engage in any commercial endeavors such as manufacturing goods, providing services, or operating other entities). Regardless of the company"s activity, a company may be considered a PIC if: (a) the company does not have a primary physical premises (e.g. it is solely domiciled c/o an attorney or other agent), or (b) the company does not have any employees, or the employees are not exclusively employed by the company or engage solely in ministerial tasks under direction of the PIC"s ultimate beneficial owners. How to complete this Appendix Please complete the sections below as directed and provide any additional information as may be required. Part 1 Non-US beneficiary/Non-US beneficial owner details Field 1 Non-US Beneficiary/Non-US Beneficial Owner Name EFTA01478185 2 Date of Birth/Date of Incorporation (mm/dd/yyyy) Guidance — If you are an individual, please enter your full name. — If you are an entity, please enter the full legal name of the entity. — If you are an individual, please enter your date of birth. — If you are an entity, please enter the entity"s date of incorporation. WM167720 023743.041516 Page 4 of 5 EFTA01478186 Part 2 Tax residency Please complete this section with the relevant information for each country in which you are tax resident. If you have additional countries of tax residence (i.e. if you need more rows than those given in the table provided), please attach a statement to this form containing the required information. Field Guidance Country/Countries of Tax Residence Enter the full name of the country in which you are resident (or the entity is resident) for tax purposes. If you are tax resident in more than one country, please include full names of the other countries in the subsequent rows of this table. Part 3 Declaration and signature Please read statements 1-3 in the applicable section (individual or entity) and confirm that the statements are, to the best of your knowledge and belief, correct and complete. Then please read the declaration and complete the signature section. Signor must be authorized to sign on behalf of the entity and must indicate the capacity in which he or she is signing the form (e.g. Trustee, Corporate/Individual Director, etc.). 0 2016 Deutsche Bank AG. All rights reserved. WM167720 023743.041516 EFTA01478187