Emirates NBD Pere ese eAyidzall Zila jleo - 610 pall guypall shAull adgai INDIVIDUAL TAX RESIDENCY SELF CERTIFICATION FORM COMMON REPORTING STANDARD Date (iad]2 |? ]2. Bol i?] aw CENumber ____Jusall aay | Customer Name (sin he pasiporo (Ga ia os) Jaa aul Muwamnao Suctan Javeo Town or City of Birth ‘salzall iza0 | Country of Birth algal ale Rawareinoi Parcistan Part 1: Country of Residence for Tax Purposes and related Taxpayer Identification Number or functional equivalent ("TIN") O gapal aia ayy Sigil gael! dolaall aly opal sauboll Ursa Please complete the following table indicating: (@_ where the Account Holder is a tax resident; Gi) The Account Holder's TIN for each country indicated. If the Account Holder is tax resident in more than three countries please use a separate sheet. Ifa TIN is unavailable please provide the appropriate reason ABorc: Reason A - The country/jurisdiction where the Account Holder is liable to pay tax 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 in the below table if you have selected ‘this reason). Reason C- No TIN is required. (Note. Only select this reason if ‘the domestic law of the relevant jurisdiction does not require the collection of the TIN issued by such jurisdiction). ‘call Isis alli Joaall Jlast pays soiluall sala dua ale (gull jliko aly JM lua bal yusnall aysill aay Gi) yan Je dll Go si pa up! alo slasall alia Gib Jb nd Abadia aaj9 elasial so a 155 cra alia ad usmall ayaill dy GE Jb na (a) ol (2) of all dbLallalall (pd cqusall casjaill ody ylsol ore full clgs dsaysall ado Lojle Gabuall wale ost Aysill dy ude Jqwaall Gluall Gale 8:3 exe 1 Gaull ali yay msl Se LIS Cand Jl yea) Lnalbo ay ol yuspall oval us dual tual ab le Jaa a Sal ee aa ols Jhisl 9d cabails) iolho juz auspall gals Assad ads -g cut 4 agisall abba ud qplaall ggilall Gl Jl cna baa teal Le (@abuil ell ge pla yaad aust aby cole Joucall ais Country of tax jual gs 3b | Taxpayer ‘yusnel aasall aay | If no Taxpayer 3253 eae Joe residence Identification Identification yall aasaill 23s Number Number available | I) aul list ras enter Reason A, B Qsial orc 1 2 3 Please explain in the following boxes why you are unable to obtain a TIN if you selected Reason B above ayaill pd) ale Jouaall leclyas eae cui anh ra eae (.) ual Atal cond flo yea ILI Slayall sas guys il 2 = 3 (Page tofa Emirates NBD a Pees etter ey Pe Part 2: Declarations and Signature @adille Gale 22 cjall J understand that the information supplied by me is covered by the full provisions of the terms and conditions governing ‘the Account Holder's relationship with Emirates NBD setting ‘out how Emirates NBD may use and share the information supplied by me. | acknowledge that the information contained in this form and information regarding the Account Holder and any Reportable Account(s) may be provided to the tax authorities of the country in which this account() is/are maintained and exchanged with tax authorities of another country or countries in which the Account Holder may be tax resident Pursuant to intergovernmental agreements to exchange financial account information. | certify that | am the Account Holder (or am authorized to sign for the Account Holder) of all the account(s) to which this form relates. | declare that all statements made in this declaration are to the best of my knowledge and belief, correct and complete. undertake to advise EMIRATES NED within 30 days of any change in circumstances which affects the tax residency status of the individual identified in this form or causes the information contained herein to become incorrect, and to provide EMIRATES NBD with a suitably updated self certification and Declaration wit in circumstances. agai «ples Go aoaiall ciloglaall gl agail ge aluall ale able Sai Gull pliailly kopll GP Cibloull Sis abies eladial dadas 3355 ypllly cxiball gus ghia Go daaaall Ciloglball cuibgll ill Ciloglaall ellisy asgaill Lia (nd diosdall Cilogleall gf yal Ohaall Go Igic gail ais bLuah sta slg ciLuall wale yaas 629 silually Bainall all cps dazyall cthLall Gul avast 94 cailly sy8l Glaly of ala duuspall SlLuall go Iglu gsaall SUSU Hlae SUls9 aypall Galyell Ups logge Gluall coke sgilall slutall Cilagiae Joliy dual dalgail Load (lull ule axdgills Lapa! ol) bull alia cally aguilg “@sgaull Kags abvall Sis SuLuallabaall guns ads as cole goa aul be gad deadall Sislaall gzag gle Glely Aloligaspaas cual apbll d paidgl 291 30 als patbgll loll li il ol aga pe gagall yasaall au pall ab le ene 3383 gl soll oo gpl Ba (ne diowall Gloolsall auai GI call 45351 91 assaill Tas Gatuulio Galea Yul rad J)5l asad av 4 sadall GUIS Go eg: 90 Jil ypibsll us. lie Signature: Lilley — gigi ignature(s) verified by ea ‘Authorised by (tage 042)