EFTA01357145.pdf

Deutsche Bank Self Certification for Entity Clients UK Automatic Exchange of Information and the OECD Common Reporting Standard (CRS) Part 4 — Country of Residence for Tax Purposes and related TIN or functional equivalent Line 10 - Country of Tax Residence• Please provide all the countries where the Entity is considered to be tax resident. Note that there may be instances where tax residence may change (for example. as a result of. but not restricted to. corporate re-structuring. changes to local or any applicable, tax laws). It is the client's responsibility to advise Deutsche Bark if there is such a change and notify Deutsche Bank within 30 days of such a change. Line 11 - Specified Person For entities tax resident in the United States (U.S.) or United Kingdom (UK) or the Crown Dependencies (Jersey. Isle of Man, and Guernsey) or Gibraltar only, please answer Yes or No to the question as to whether the entity is a Specified Person. Line 12 - Local Tax Identification Number MNI Provide the Entity local Tax Identification Number ("TIN"). If you are not able to provide Deutsche Bark with a TIN number. please provide the reason in the line 14. Line 13 - TIN Type Provide the TIN type. Some examples may include local Tax Identification Number, Employer Identification Number. Corporation Tax Identification Number/Reference. tine 14 - No TIN available If you are not able to provide a TiN, please provide one of the mentioned reasons. Line 15 - Confirmation of Completeness• Please tick that box to certify that for the purposes of taxation the Account Holder is not tax resident in any other country other than the countries indicated in Part 4. Part 5 — Declaration and Signature Please ensue that you have the authority to sign on behalf of the Entity. Please sign and date the form in this part. SN Cerbluxit00 b Entry Chet' -CRS IVK FATCA -17/2016 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0043512 CONFIDENTIAL SDNY_GM_00189696 EFTA01357145