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U.S. Foreign Account Tax Compliance Act
FinMarket is a brand name owned and operated by K-DNA Financial Services LTD (hereinafter called the “Company” or “K-DNA Financial Services LTD”), a company regulated by the Cyprus Securities and Exchange Commission license 273/15, incorporated and registered under the laws of the Republic of Cyprus, registration No. 335683, head office at 56 Griva Digeni Avenue, Anna tower, First floor, 3603, Limassol, Cyprus.
Dear Client, As a part of your registration process with K-DNA Financial Services LTD, you are required to complete and sign the below declaration form, in order to enable the Company to assess your information, for its compliance with the FATCA Regulation issued by the US Treasury.
Please note that under the FATCA Regulation a US Reportable Person is classified as:
• A U.S. Citizen (having the US Citizenship – including also dual citizen)
• A U.S. Resident for tax purposes
• A domestic partnership / corporation
• Any estate other than a foreign estate
• A US Person holding ownership (more than 10% of the shares (vote or value shares) of a corporation/ partnership/ trust
• Any trust :
(a) for which any U.S. Court is able to exercise primary supervision for its administration;
(b) where one or more U.S. Persons are authorized to exercise control on all fundamental decisions of the trust; and
(c) Any other person that could not be regarded as a foreigner.
U.S. Tax Residency Status Declaration Form
- Please tick if any of the below applies to you:
U.S. citizenship or lawful permanent resident (green card) status;
A U.S. birthplace (or certificate of incorporation for legal entity / partnership with United States address)
A U.S. residence address or a U.S. correspondence address (including a U.S. P.O. box);
A U.S. current telephone number
Standing instructions to transfer funds to an account maintained in the United States, or directions
regularly received from a U.S. address;
An “in care of” address or a “hold mail” address that is the sole address with respect to the client; or
A power of attorney or signatory authority granted to a person with a U.S. address
A US Tax Identification Number (TIN)
All the above mentioned are not currently applicable to me.
I (Full name) ____________________, Passport number_____________________, hereby confirm that all the statements made in this Declaration Form are complete true and accurate, and provided on myown initiative. I hereby agree to be fully liable for the information provided.
In the case of any change or amendment in the information provided herein I remain responsible to notify K-DNA Financial Services LTD.
Full Name__________________ Signature_______________________ Date _______________________
Tel: + (357) 25 654 134 Email: [email protected]FINMARKET.com Web: www.FINMARKET.com
FINMARKET is a brand name owned and operated by K-DNA Financial Services Ltd, 56 Griva Digeni
Avenue, Anna tower, First floor, 3063, Limassol, Cyprus, is a Cyprus Investment Firm (CIF) supervised
and regulated by the Cyprus Securities and Exchange Commission (CySEC) with CIF Licence number
273/15 and Company registration number HE 335683.
© 2017 K-DNA FINANCIAL SERVICES LTD ALL RIGHTS RESERVED