Please complete this section and tick in the "Yes" or "No" respectively for each of the following questions:
Are you a U.S. citizen or resident?
(U.S. Passport/green card holder, U.S. taxpayer, etc.)
Is U.S. your place of birth?
Do you hold a current U.S. residence address /
mailing address and U.S. post office box?
Do you have a current U.S. telephone number?
Standing instructions to pay amounts from Phillip Mutual account to an account maintained in the U.S.?
Note: All investors (individual & legal entity(s) or corporate) are required to complete the following declaration.
Please tick one of the following:
I am a U.S. person / U.S. legal Entity(s) Please provide Form W-9
I am a Non-U.S. person with No U.S. Indicia
I am a Non-U.S. person / Non-U.S. Legal Entity(s) with one or more U.S.Indicia. Please provide Form W-8BEN/provide Form W-8BEN-E.
I/We declare that i have examined the information on this form and to the best of my knowledge and belief it is true,
correct and complete.
I/We hereby consent for Company that Company shall have right to provide my/our personal data and information to regulatory
authorities in accordance with the requirements of Foreign Account Tax Compliance Act(FATCA) as may be stipulated by
applicable laws, regulations, agreement or regulatory guidelines or directives.
If there is any update to the account information/FATCA
status or if updates reveal any U.S. indicia or change to FATCA status,
I/We hereby agree to notify and furnish Company with the relevant documentary evidence within 30 Days of such change.
I/We consent to and authorise Company to perform any of the following, if applicable:
1. Withhold any applicable payments in the account.
2. Report or disclose all relevant information relating to or arising from account.
3.Terminate (with prior notice) my/our contractual relationship(s) with Company
Please attach your scanned Identification Card or Passport. If not available, please fax or send via mail
through the following fax no: 03-27113036 or mailing address :
1. A signed Account Opening Form.
2. A photocopy of your IC(both sides)/passport.
Email : firstname.lastname@example.org
B- 2- 7, Megan Avenue II
No. 12 Jalan Yap Kwan Seng
50450 Kuala Lumpur
Upload Your IC or Passport here :(Attachment Format : JPEG, DOC, DOCX, PDF, TIF, GIF, JPG only)
Declarations and Acceptance
I/We confirm that I/We have received, read and fully understood the Terms and Conditions of use and other terms and conditions
I/We is/are eligible to apply for the units in the collective investment scheme.
I/We hereby consent to the disclosure of information to the relevant entities including the Securities Commission
I/We acknowledge that the principal Applicant/Holder shall have the absolute authority to operate the account and/or any
transactions pertaining to the account
For Online Transaction
Phillip Mutual Berhad's online facilities are supported by computer-based component systems for opening of account and other
online transactions in relation to unit trusts. As with all facilities and computer systems, you will be exposed to the risks associated
with the systems including the failure of hardware and software.The result of any system failure may cause a delay in processing
You also acknowledge that you are exposed to the inherent risks of conducting internet transactions and that you assume
I/We hereby confirm that all the information given is true and accurate and that I/We have read and understood the Propectus,
Supplementary (if any) and Terms and Conditions and Unit Trust Loan Financing Risk Disclosure applicable to this transactions
and before investing