FATCA and CRS – Individual and Controlling Person Self-Certification

Please consult your professional tax advisor on your tax residency and any related guidance on the Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS).

NOTES FOR COMPLETING THIS FORM – the form does not save details entered and information will be lost if it is not completed and submitted in one go.  To assist you to do this, you will need the following information before starting:

  • Nedbank CIS number(s) – this can be found on the communication we sent to you
  • Your SA ID number
  • Your foreign passport number if applicable
  • All Nedbank CIS number(s) of entities or account holders for which you are a controlling person
  • Registration number of entity for which you are a controlling person
  • Both SA and foreign tax identification number(s) as applicable

Completing the form takes 5 - 8 minutes.

Please note that, for the purposes of this document, a number of the technical terms used in the self-certification form are defined in the attached glossary of terms; which can be accessed through the following link: 

Glossary of terms for individual and controlling person self-certification

If you do not want to click on a link, please type the following address in your browser:

https://www.nedbank.co.za/content/nedbank/desktop/gt/en/supplimentary/fatca_crs-individual-glossary.html

Part 1 - Identification of accountholder / controlling person

Please provide all identification types, countries and numbers, applicable to accountholder/controlling person:

Physical Address

If your address has changed and / or is different to the information on our records, we will ask you to bring proof into the branch to enable us to re FICA (Financial Intelligence Centre Act) you.

South African or Foreign address?

Postal Address

South African or Foreign address?

Part 2 - Certify citizenship, nationality and country of tax obligation

Please select appropriate options:

Do you have tax obligations, tax liabilities or tax residencies outside of South Africa?

Are you a US citizen, a US person or a US national ?

The fact that you are a US citizen or a US person means that you do have tax obligations outside of South Africa. Please provide the correct answer to the question "Do you have tax obligations, tax liabilities or tax residencies outside of South Africa?"

We also need a completed IRS W-9 form from you because you are a US citizen, a US person or a US national. Please scan and email the form to FATCACRS@Nedbank.co.za. Please note that if you do not provide us with this document, your account will be flagged as non-compliant and reported as such to SARS.

We need a completed IRS W-9 form from you because you are a US citizen, a US person or a US national. Please scan and email the completed form to FATCACRS@Nedbank.co.za. Please note that if you do not provide us with this document, your account will be flagged as non-compliant and reported as such to SARS.

 

The fact that you were born in the US implies that you are a US citizen or US national but you have answered "No" to the question, "Are you a US citizen, a US person or a US national?" This means that you have renounced your US citizenship. If this is the case, we need you to provide a completed IRS W-8-BEN form and a copy of the Certificate of Loss of Nationality. Please scan and email these documents to FATCACRS@Nedbank.co.za. Please note that if you do not provide us with these documents, your account will be flagged as non-compliant and reported as such to SARS.

We need a completed IRS W-8-BEN form from you to certify that you are NOT a US citizen, a US person or a US national. If you do not have this document with you, please scan and email it to FATCACRS@Nedbank.co.za. Please note that if you do not provide us with this document, your account will be flagged as non-compliant and reported as such to SARS.

 

Part 3 - Accountholder's/controlling person's tax residency

Please complete the table below for all countries where you have tax obligations, tax liabilities or tax residencies.

Part 4 - Entity/Entities that hold(s) account(s) at Nedbank and in relation to which you are a controlling person, if applicable:

Nedbank CIS number(s) - can be found on the communication we sent to the entity account holder

Part 5 - Declarations and acceptance of terms and conditions

I, the undersigned:

(i)  certify that all statements made in this declaration are, to the best of my knowledge and belief, correct and complete;

(ii)  undertake to advise Nedbank within 30 days of any change in circumstances that affects the accountholder's tax residency, status and/or causes the information contained herein to become incorrect, and to provide Nedbank with an updated self-certification (this form) within 90 days of such change in circumstances;

(iii)  understand that the information contained in this form and information regarding any reportable account(s) may be provided to the South African Revenue Service, and exchange with tax authorities of other countries, in terms of South African tax legislation;

(iv) undertake to notify the accountholder of the completion of this form and advise them that the information in this form and information regarding any reportable account(s) may be provided to the South African Revenue Service, and exchange with tax authorities of other countries, in terms of South African tax legislation; and

 (v) understand that, by selecting "Yes"  below it is deemed that I have attached my signature to this document.

If signing under a power of attorney, please provide a copy of the power of attorney by scanning and sending it via e-mail to the following e-mail address: FATCACRS@NEDBANK.CO.ZA  

Please tick to confirm that you accept the above mentioned terms.

Please note that you cannot continue if you have not accepted the terms and conditions. If you do not accept, we will be required to issue a letter of non-compliance.