KEQ Customer Form

INSTRUCTIONS

Please read these instructions before completing the form

Why are we asking you to complete this form?

Regulations based on Foreign Account Tax Compliance Act (FATCA) and Common Reporting Standard (CRS) require KAF to collect and report certain information about an account holder’s tax residency. If the account holder's tax residence is located outside Malaysia, we may be legally obliged to pass on the information in this form and other financial information with respect to your financial accounts to Lembaga Hasil Dalam Negeri (Inland Revenue Board of Malaysia) and they may exchange this information with tax authorities of another jurisdiction or jurisdictions pursuant to intergovernmental agreements to exchange financial account information.

For the list of definitions, kindly refer the Appendix attached at the the back of this form.

This form will remain valid unless there is a change in circumstances relating to information, such as the account holder’s tax status or other mandatory field information that makes this form incorrect or incomplete. In that case you must us and provide an updated self-certification.

Who should complete the FATCA/CRS Individual Self-Certification Form:

Individual Account Holder /Sole Trader/ Sole Proprietor
Joint or Multiple Account Holders*

Notes:

This Form should not be applicable to any local resident with a Malaysian tax registration.
This Form should not be applicable to foreign citizen who are Malaysian residents for tax purposes.
However, this Form shall be applicable if a Malaysian tax resident is also a tax resident in another jurisdiction.
Under FATCA, if the Account Holder is a U.S. tax resident under U.S. law, you should indicate that the account holder is a U.S. tax resident on this form and you may also need to fill in an IRS W-9 form.
If you have already provided information in relation to your FATCA, you may still need to provide additional information for the CRS as this is a separate regulation.

* For Joint or Multiple Account Holders, kindly complete and submit a separate form for each account holder.

Where to go for further information

If you have any question about this form, these instructions, or defining your tax residency status, please liaise with your tax adviser or local tax authority.

You can also find out more, including a list of jurisdictions that have signed agreements to automatically exchange information, along with details about the information being requested, at US IRS website or the OECD automatic exchange of information portal.

IMPORTANT: PLEASE COMPLETE THE FORM IN CAPITAL LETTERS AND BLACK INK ONLY, AND WHERE APPLICABLE.

Tax Residency

Country/Jurisdiction of Tax Residence	TIN	If no TIN is available, please tick on the appropriate reason**	If Reason B is selected, explain why TIN is not available
		A B C
		A B C

Important: If the entity or organisation is a tax resident in more than the countries/jurisdictions stated above, please use a separate sheet

**
Reason A – The country/jurisdiction where the Account Holder is resident does not issue TINs to its residents.
Reason B – The Account Holder is otherwise unable to obtain a TIN or equivalent number. (Please explain why you are unable to obtain a TIN if you have selected this reason)
Reason C – No TIN required. (Only select this reason if the domestic law of the relevant jurisdiction does not require collection of the TIN issued by such jurisdiction)

Client Informations Update

PERSON DETAILS SECTION

Declarations By Client