CRS Form for Tax Residency Self Certification (Individual, Joint and Sole Proprietorship Accounts) Coe ase read these instructioss carefully before completing the form” nas a of Income Tax Rules, 2002 and Regulations based on the OECD Common Reporting Standard (CRS) require Ms Jank Limited to collect and report certain information about each person's tax residency. If your tex residence located outside Pakistan and/or United States of America (USA), we may be legally ‘obliged to pass on the information in this form and other financial information with respect to your financial accounts to Federal Board of Revenue (FBR) and they may exchange this information with tax authorities of another jurisdiction or jurisdictions pursuant to intergovernmental agreements to exchange financial account information. You can find summaries of defined terms in the Glossary of Terms provided at page 3 of this form. ragase complete this form i you ae an individual, a sole trader or sole proprietor. Please use 2 $60 individual ofa Joint Account In case of Minor Account, guardian should complete this form on behalf - minor. ate form for each ‘of account holder Be form will remain valid unless there is a change in circumstances relating to information, such as the account 'older’s tax status or other information that makes this form incorrect or incomplete. In that case you must notify us and provide an updated self-certification. ACCOUNT HOLDER INFORMATION Rosen ce voumww: JIS8-O|-198€ Een TownorciyotBien: Cabs EJAZ AHMAD Country of Birth: Mailing Addres Address Line 1: 4 et Fin T, Sell, Men: Address Line 1: Addr Line 2: 5s Line iress Line Alt fi Mey. 2° Address Line 2: city: Jingut iy: Province/State: C, ryeonpsingnain Ad Province/Stat Country: 0 Kor Country: ach: cA ¥ ‘CRS — DECLARATION OF TAX RESIDENCY 1am tax resident of Pakistan or/and USA ONL [7 ves (Proceed to Part 4) 7 No (Proceed to Part 3) caatestion Form (082017) Pages of3 Scanned with CamScanner} CRS Form for Tax Residency Self Certification (Individual, Joint and Sole Proprietorship Accounts) COUNTRY OF RESIDENCE FOR TAX PURPOSE tax purposes and (i) Please complete the following tale indicating (the country where the Account Holder i resident for the Account Holders Taxpayer identification Number (IN) or functional equivalent for each country indicated. Please fer to the OECD website for more information on tax residency http://wunw.o /automatic-exch implementation-and-assistance/tax-residen ETN Is not avaiable, please tick (7) the appropriate box with reason A, 8 or Cas defined below and provide Supporting vidence: 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 Reason C- No TIN is required. (Note: Only select this reason, along-with evidence, i the domestic law ofthe relevant country does not require the collection ofthe TIN issued by such country) Tick (7) ONE only for each country Reason 8 Reason C ‘Tax identification Number | Reason A Country(ies) of Tax Residence (FIN) or Functional (Please provide Equivalent reasons if this box ticked) 2 3 Tf Reason 6 selected, please explain In the following box(es) why you are unable to obtain a TIN or Functional Equivalent 1 2 3 CUE DECLARATION AND SIGNATURE | 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 Meezan Bank Limited setting out how Meezan Bank Limited 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/jurisdletion In which this accountls) is/are maintained and exchanged with tax authorities of another country/jurisdiction or countries/jurisdictions in which the Account Holder may be tax resident pursuant to intergovernmental agreements to exchange financial account information. I dectare that all statements made in this declaration are, to the best of my knowledge and belief, correct and complete. | undertake to submit a suitably updated Form within 30 days of any change In cleumstances which affects the tax residency status or where any information contained herein to become incorrect. cusonerssignure EI oate_S-24y-202) For Bank use onl Please input detalls of this Form in the Core Banking System, Name of Incputter: Signature: Signature; Branch/ Operation Manager Name: xs st criteton Form (062007) Page 2of3 Scanned with CamScannerCRS Form for Tax Residency Self Certifi (Individual, Joint and Sole Proprietorship Accounts) Ae Reon Oho 1m case customer has the following Indicia/indication pertaining to a forcign coun resident in the respective country, he/she Is required to provide relevant Curing Documents 25m fry and yet declares self to be non-tax fentioned below: CRS Indicia/indication Observed Residence/mailing address ina country other than Pakistan or/and USA Telephone number in a country other than Pakistan or/and USA ‘Mandate Holder of account having residence/ mailing address in a country other than Pakistan or/and USA “Hold mall” or “in care of address in 8 country other than Pakistan or/and usa Documentation required for Cure of CRS Indicia Guan reavonable written explanation along-with relevant documentary cevidence(s). sxamples of reasonable explanation may Inude a statement By the indvival that he/she: (1) isa student or teacher or trainee with a foreign holds the appropriate visa: (2) is assigned to a diplomatic post ora pos! foreign address/contact number; (3) isa seafarer or frontier worker or empl travelling between countries/jurisdictions. address/contact number and ition in a consulate or embassy with @ loyee working on a truck or train (4) visited, for example, United Kirigdom for leisure/holidays for less than 6 tronthss therefore, his/her NICOP shows the Current Address/Country of Stay of the United Kingdom. Examples of documentary evidence(s) are 2s follows: Copy of Passport, Visa and/or other documentary evidence establishing the non- tax resident status of relevant foreign country. you with the completion of this form. Further details Note: These are selected summaries of defined terms provided to assist to the CRS at the ‘an be found within the OECD Common Reporting Standard and the associated Commentary http//wmw.oeed.org/tax/transparency/automaticexchangeofinfarmation.htmm crs CRS is the Common Reporting Standard under which member states of the European Union and countries that have concluded Competent Authority Agreements exchange financial account information. Participating Country/turisdiction Participating country/jurisdiction means a juris there is an obligation in place to provide the certain information, available on F8R’s web portal. sdiction/country () with which gn agreement is in place pursuant to which ‘nd (i) which is identified in a published list to be made Reportable Account ‘The term “Reportable Account” means an account held by one or more Reportable Persons. Reportable Jurisdiction Reportable Jurisdiction means al jurisdictions other than Pakistan and the United States of America; Reportable Person A Reportable Perso that jurisdiction. {s defined as an individual who is tax resident in a Reportable Jurisdiction/country under the tax laws of ‘TIN (Ineluding Functional Equivalent) ‘TIN means Taxpayer Identification Number or any other functional equivalent. A TIN is a unique combination of letters or numbers assigned by a country/jurisdiction to an individual or an Entity and used to identify the individual or Entity for the purposes of administering the tax aws of such country/jursdiction. cas satrcrteaon era (00201 os2037 Pageaofs Scanned with CamScanner