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    FATCA

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    muslimnsw
    This document is a FATCA form for BRAC Bank account holders. It collects information about the account holder's country of residence, country of birth, U.S. status, and other indicia of U.S. tax status. The account holder confirms that the information provided is true and accurate, and consents to the bank sharing their information with tax authorities as required by law and withholding amounts from their account if necessary for tax purposes.

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    FATCA

    Uploaded by

    muslimnsw
    28 views1 page
    This document is a FATCA form for BRAC Bank account holders. It collects information about the account holder's country of residence, country of birth, U.S. status, and other indicia of U.S. tax status. The account holder confirms that the information provided is true and accurate, and consents to the bank sharing their information with tax authorities as required by law and withholding amounts from their account if necessary for tax purposes.

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    This document is a FATCA form for BRAC Bank account holders. It collects information about the account holder's country of residence, country of birth, U.S. status, and other indicia of U.S. tax status. The account holder confirms that the information provided is true and accurate, and consents to the bank sharing their information with tax authorities as required by law and withholding amounts from their account if necessary for tax purposes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    28 views1 page

    FATCA

    Uploaded by

    muslimnsw
    This document is a FATCA form for BRAC Bank account holders. It collects information about the account holder's country of residence, country of birth, U.S. status, and other indicia of U.S. tax status. The account holder confirms that the information provided is true and accurate, and consents to the bank sharing their information with tax authorities as required by law and withholding amounts from their account if necessary for tax purposes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    www.bracbank.

    com

    Foreign Account Tax Compliance Act (Fatca) Form*

    Account Number:

    Relation with the account: Owner/proprietor/signatory/Director/Beneficial Owner/Mandate/others:

    Name :

    Country of Residence :

    Country of Birth :

    Status
    Indicia of U.S. Status Check “9”

    1. Are you a U.S. Resident? Yes No

    2. Are you a U.S. Citizen? Yes No

    3. Do you hold a U.S. Permanent Resident Card (Green Card)? Yes No

    4. Do you have a U.S. address (including P.O. Box) or U.S. phone number or U.S. e-mail address? Yes No

    5. Have you granted Power of Attorney to someone who has a U.S. address or U.S. phone number or Yes No
    U.S. e-mail address?

    6. Do you receive payments sourced from USA? That is Interest, Dividend, Rent, Payment for services Yes No
    (salaries) and any other Fixed Determinable Annual Periodical [FDAP] income.

    7. Are you Citizen/National of any other country except U.S. and Bangladesh? Yes No
    If yes, please mention:_______________________________________________________________

    I hereby confirm the information provided above is true, accurate and complete. In any event if this statement is identified as false,
    I hereby consent for BRAC Bank Limited to treat my account as per the directions of FATCA.
    I hereby consent for BRAC Bank Limited or any of its affiliates (including branches) to share my/ our entity information with domestic
    or overseas regulators or tax authorities where necessary to establish my tax liability in any jurisdiction (if required).
    Where required by domestic or overseas regulators or tax authorities, I consent and agree that the Bank may withhold from my
    account(s) such amounts as may be required according to applicable laws, regulations and directive.
    I undertake to notify BRAC Bank Limited within 30 calendar days if there is a change in any information which I have provided to the Bank.

    Name: _______________________________________ Signature: _______________________________________

    Date : _______________________________________

    * Supplement to Account Opening Form

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