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.)
|2.||Is U.S. your place of birth?||Yes No|
|3.||Do you hold a current U.S. residence address / mailing address and U.S. post office box?||Yes No|
|4.||Do you have a current U.S. telephone number?||Yes No|
Standing instructions to pay amounts from Phillip Mutual account to an
account maintained in the U.S.?
All investors (individual, legal entity or corporate) are required to complete the following declaration.
|Name||Country of Tax Residence||Tax Identification No|
Declaration for Foreign Account Tax Compliance Act (“FATCA”) and Common Reporting Standard (“CRS”)
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 Phillip Mutual Berhad (PMB) that PMB 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) and Common Reporting Standard (CRS) for the Automatic Exchange of Financial Account Information as may be stipulated by applicable laws, regulations, agreement or regulatory guidelines or directives.
If there is any update to the account information/ FATCA/ tax residency status/ controlling persons or if updates reveal any change of U.S. indicia or change to FATCA status or tax residency status or controlling persons, I/We hereby agree to notify and furnish PMB with the relevant documentary evidence within 30 Days of such change.
I/We consent to and authorise PMB to perform any of the following, if applicable:
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
INDIVIDUAL APPLICANT 'S DETAILS
Mother Maiden Name
|Nature of Business|
|Present Annual Incomee|
|Estimate Net Worth|
|Source of Current Annual Income|
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