Please complete in BLOCK letters 請以正楷填寫此表格 1. Controlling Person Information 控權人個人資料 Name of Controlling Person 控權人姓名 [Surname 姓 ] [Given Name & Middl

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Controlling Person Tax Residency Self-Certification Form (CRS) 控權人稅務居民身份自我證明表格通用報告準則 Important Notes 重要事項 : Tax law and regulations (including but not limited to the Inland Revenue Ordinance (Cap.

1 Controlling Person Tax Residency Self-Certification Form (CRS) 控權人稅務居民身份自我證明表格通用報告準則 Important Notes 重要事項 : Tax law and regulations (including but not limited to the Inland Revenue Ordinance (Cap.112) and regulations based on the Organisation for Economic Co-operation and Development (OECD) Common Reporting Standard (CRS) for automatic exchange of information) require Manulife to collect and report information about tax residence. In certain circumstances, Manulife may be obliged to provide certain information to governments, regulators and tax authorities concerning your tax residency and other tax-relevant data. 稅務法律及規例 ( 包括但不限於稅務條例 ( 第 112 章 ) 和根據自動交換資料有關的經濟合作與發展組織 (OECD) 通用報告準則 ( CRS) 的規則 ) 要求宏利收集及申報關於稅務居民的資料在部份情況下, 宏利可能有義務向政府監管機構或稅務當局提供有關閣下稅務居民及與稅務相關的資料 This is a mandatory self-certification provided by you to Manulife for the purpose of automatic exchange of financial account information. The data collected may be transmitted by Manulife to the Inland Revenue Department for transfer to the tax authority of another jurisdiction, and/or directly to the tax authority of another jurisdiction. 這是由閣下向宏利提供的自我證明, 以作自動交換財務帳戶資料用途宏利可把收集所得的資料交給稅務局, 稅務局會將資料交到另一稅務管轄區的稅務當局, 及 / 或直接交給另一稅務管轄區的稅務當局 As a financial institution, Manulife is not allowed to give tax or legal advice. If you have any questions regarding your tax residency, please consult your tax adviser or the information for CRS at the following links at and 宏利不獲允許提供稅務或法律意見若閣下對您的稅務居民狀態存有任何疑問, 請詢問專業稅務顧問或瀏覽及網站 CRS 資料 If a valid CRS self-certification or a reasonable explanation and documentation (as appropriate) supporting the reasonableness of the CRS self-certification is not provided, you will be deemed as a reportable person of the country/jurisdiction for which your personal information indicated. 假如閣下未能提供有效的 CRS 自我證明或合理解釋和證明文件 ( 如適用 ) 以支持 CRS 自我證明的合理性, 閣下一律被視為其所持有個人資料之所屬國家 / 司法管轄區的申報對象 *OBJTSELFCERTCP* *OBJTSELFCERTCP* Page 1 of 5

2 Please complete in BLOCK letters 請以正楷填寫此表格 1. Controlling Person Information 控權人個人資料 Name of Controlling Person 控權人姓名 [Surname 姓 ] [Given Name & Middle Name(s) 名 ] Date of Birth 出生日期 [DD/MM/YYYY ( 日 / 月 / 年 )] Place of Birth Hong Kong 香港 Macau 澳門出生地點 Other 其他 [City 城市 ] [Country 國家 ] Residential Address 住宅地址 [Room/Flat 室 /Floor 樓 /Block 座 ] [Name of Estate/Village/Building 屋村 / 大廈名稱 ] [Number and Name of Street/Road 街道名稱及號碼 ] [Name of Area 區域 /District 地區 /Postal Code 郵寄代碼 ] [City 城市 ] [Country 國家 ] Please state the name of the Entity account holder of which you are a Controlling Person. 請填寫你作為控權人的實體帳戶持有人的名稱 Page 2 of 5

3 2. Controlling Person Tax Status 控權人稅務狀況 Please complete the following table indicating all countries / jurisdictions (including Hong Kong) where you are a resident for tax purposes and Taxpayer Identification Number or its Functional Equivalent (TIN) for each country / jurisdiction. Please use a separate sheet if more than 3 countries. 請在以下列明您在所有國家 / 司法管轄區 ( 包括香港 ) 符合稅務的居民的稅務編號或具有等同功能的識辨編號 ( 稅務編號 ) 如多於 3 個國家, 請使用另外紙張 Your Name, Date of Birth, Place of Birth, and Residential Address as completed in Part I will be considered as your self-certification and applied to the following section. 您在第一部分填寫的姓名出生日期出生地點及住宅地址將被視為您的自我證明並適用於以下部分 Applicant s Tax Residence 申請人稅務居住地 I hereby declare that, to the best of my knowledge and belief, I am (please tick on 以本人據知及所信, 在此聲明本人 ( 請選一項 ): (i) a tax resident of Hong Kong only 只是香港的稅務居民 (ii) a tax resident of Hong Kong and also some other jurisdictions or countries 是香港及其他司法管轄區或國家的稅務居民 (iii) not a tax resident of Hong Kong, but instead a tax resident of some other jurisdictions or countries 不是香港的稅務居民, 而是其他司法管轄區或國家的稅務居民 If you have any foreign indicia (e.g. nationality, place of birth, residential address / correspondence / office address, contact number, etc), please provide your explanation for not being a tax resident of the country / jurisdiction. 如果您有任何外籍標記 ( 例如 : 國籍, 出生地點住宅 / 通訊 / 辦公地址聯繫電話等 ), 請在以下方框內解釋不屬於此國家 / 司法管轄區的稅務居民之原因 If a is put in tick box (ii) or (iii) above, please provide the following information of each country/jurisdiction of the tax residence. 如上述選擇為 (ii) 或 (iii), 請根據各個稅務居住地填寫以下資料 Country/Jurisdiction of Tax Residency 稅務居民所在國家 / 司法管轄區 TIN 稅務編號 If no TIN available, enter Reason A, B or C 若未能提供稅務編號, 填上理由 A B 或 C Please explain why you are unable to obtain a TIN if you selected Reason B. 若您選擇理由 B, 請在下方解釋無法取得稅務編號的原因 Remarks 註 : If you are Hong Kong Identity card holder, the TIN is the Hong Kong Identity Card Number. 若您是香港居民身份證持有人, 稅務編號為閣下的香港居民身份證號碼 If you are PRC Resident Identity Card holder, the TIN is the PRC Resident Identity Card Number. 若您是中華人民共和國居民身份證持有人, 稅務編號為閣下的中華人民共和國居民身份證號碼 Reason A: The country/jurisdiction where the account holder is a resident for tax purposes does not issue TINs to its residents. 理由 A 帳戶持有人在當地為稅務居民的國家 / 司法管轄區不向其居民發出稅務編號 Reason B: The account holder is unable to obtain a TIN. (Please explain why you are unable to obtain TIN in the above table if you have selected this reason.) 理由 B 帳戶持有人無法獲得稅務編號 ( 若您選擇這理由, 請在上表解釋閣下無法獲得稅務編號的原因 ) Reason C: No TIN is required. (Note: Only select this reason if the domestic law of the relevant jurisdiction of residence does not require the TIN to be disclosed.) 理由 C 無需稅務編號 ( 註 : 只有在相關司法管轄區的國內法律不需要披露該司法管轄區發出的稅務編號方可選擇這理由 ) Page 3 of 5

4 3. Type of Controlling Person 控權人類別 Please one only. 就其中一個適當方格內加上號 Type of Entity 實體類別 Legal Person 法人 Trust 信託 Legal Arrangement other than Trust 除信託以外的法律安排 Type of Controlling Person 控權人類別 Individual who has a controlling ownership interest (i.e. not less than 25% of issued share capital) 擁有控制股權的個人 ( 即擁有不少於百分之二十五的已發行股本 ) Individual who exercises control/is entitled to exercise control through other means (i.e. not less than 25% of voting rights) 以其他途徑行使控制權或有權行使控制權的個人 ( 即擁有不少於百分之二十五的表決權 ) Individual who holds the position of senior managing official/ exercises ultimate control over the management of the entity 擔任該實體的高級管理人員 / 對該實體的管理行使最終控制權的個人 Settlor 財產授予人 Trustee 受託人 Protector 保護人 Beneficiary or member of the class of beneficiaries 受益人或某類別受益人的成員 Other (e.g. individual who exercises control over another entity being the settlor/trustee/protector/beneficiary) 其他 ( 例如 : 如財產授予人 / 受託人 / 保護人 / 受益人為另一實體, 對該實體行使控制權的個人 ) Individual in a position equivalent/similar to settlor 處於相等 / 相類於財產授予人位置的個人 Individual in a position equivalent/similar to trustee 處於相等 / 相類於受託人位置的個人 Individual in a position equivalent/similar to protector 處於相等 / 相類於保護人位置的個人 Individual in a position equivalent/similar to beneficiary or member of the class of beneficiaries 處於相等 / 相類於受益人或某類別受益人的成員位置的個人 Other (e.g. individual who exercises control over another entity being equivalent/similar to settlor/trustee/protector/beneficiary) 其他 ( 例如 : 如處於相等 / 相類於財產授予人 / 受託人 / 保護人 / 受益人位置的人為另一實體, 對該實體行使控制權的個人 ) Page 4 of 5

5 4. Declaration and Acknowledgement 聲明及確認 I declare that the information given and all statements made in this self-certification (which includes any separate sheet(s)) are, to the best of my knowledge and belief, true, correct and complete. 本人聲明就本人所知所信, 本自我證明 ( 包括使用另外紙張 ) 內所填報的所有資料和聲明均屬是真實正確及完備 I 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 Manulife setting out how Manulife may use and share the information supplied by me. 本人明白, 本人提供之資料受管限帳戶持有人與宏利之間關係的全部條款及條件規定所限, 該等規定列明了宏利可如何使用及分享本人提供之資料 I undertake to advise Manulife of any change in circumstances which affects the tax residency status of the individual identified in this self-certification or causes the information contained herein to become incorrect or incomplete, and to provide Manulife with a suitably updated self-certification within 30 days of such change in circumstances. 本人承諾, 如情況有所改變, 以致影響本自我證明所述的個人的稅務居民身份, 或引致本自我證明所載的資料不正確或不完整, 本人會通知宏利, 並會在情況發生改變後 30 天內, 向宏利提交一份適當更新的自我證明 I acknowledge and agree that (a) the information contained in this self-certification is collected and may be kept by Manulife for the purpose of automatic exchange of financial information and (b) such information and information regarding the controlling person and any reportable account(s) may be reported by Manulife to the Inland Revenue Department of the Government of the Hong Kong Special Administrative Region and exchanged with the tax authorities of another country/countries and jurisdiction(s) in which the controlling person may be resident for tax purposes, pursuant to the legal provisions for exchange of financial account information provided under the Inland Revenue Ordinance (Cap.112) and (c) I agree to the obligation that the Controlling Person must comply with requests made by Manulife to comply with the CRS (AEOI) requirements under the Inland Revenue Ordinance and/or applicable law and regulation, and such obligation forms the basis of the policy to be issued. 本人確認及同意, 宏利可根據稅務條例 ( 第 112 章 ) 有關交換財務帳戶資料的法律條文,(a) 收集本自我證明所載資料並可備存作自動交換財務帳戶資料用途及 (b) 把該等資料和關於控權人及任何須申報帳戶的資料向香港特別行政區政府稅務局申報, 從而把資料轉交到控權人的居留司法管轄區的稅務當局及 (c) 本人同意控權人必須遵守宏利的要求以便遵守稅務條例及 / 或適用法律及規例的 CRS(AEOI) 規定, 並為日後簽發保單之基礎 I confirm that I have received and read the Notice to Customers relating to the Personal Data (Privacy) Ordinance (version ) ( Notice ). I understand and agree to the Notice. 本人已收訖及閱有關個人資料 ( 私隱 ) 條例的客戶通知 ( 版本 ) ( 通知 ) 本人同意及確認該通知 I certify that I am the controlling person of all the account(s) held by the entity account holder to which this form relates. 本人證明, 就與本表格有相關的實體帳戶持有人所持有的帳戶, 本人是控權人 Signature of Controlling Person: 控權人簽署 Date (DD/MM/YYYY): 日期 ( 日 / 月 / 年 ) WARNING: It is an offence under section 80(2E) of the Inland Revenue Ordinance if any person, in making a self-certification, makes a statement that is misleading, false or incorrect in a material particular AND knows, or is reckless as to whether, the statement is misleading, false or incorrect in a material particular. A person who commits the offence is liable on conviction to a fine at level 3 (i.e. HK$10,000). 警告 : 根據稅務條例第 80(2E) 條, 如任何人在作出自我證明時, 在明知一項陳述在要項上屬具誤導性虛假或不正確, 或罔顧一項陳述是否在要項上屬具誤導性虛假或不正確下, 作出該項陳述, 即屬犯罪一經定罪, 可處第 3 級 ( 即 HK$10,000) 罰款 Page 5 of 5

Microsoft Word - (web)_F.1_Notes_&_Application_Form(Chi)(non-SPCCPS)_16-17.doc

Microsoft Word - (web)_F.1_Notes_&_Application_Form(Chi)(non-SPCCPS)_16-17.doc 聖保羅男女中學學年中一入學申請申請須知申請程序 : 請將下列文件交回本校 ( 麥當勞道 33 號 ( 請以 A4 紙張雙面影印, 並用魚尾夾夾起 : 填妥申請表並貼上近照小學五年級上下學期成績表影印本課外活動表現及服務的證明文件及