致To京华山一国际（香港）有限公司CorePacific-.PDF

致To ：京華山一國際 (香港)有限公司 Core Pacific-Yamaichi International (H.K.) Limited 京華山一期貨 (香港)有限公司 Core Pacific-Yamaichi Future (H.K.) Limited (下稱「京華山一」collectively referred as to “CPY” ） 地址Address ：香港灣仔港灣道26 號華潤大廈 11 樓 11/F, China Resource Building, 26 Harbour Road, Wanchai, HK 客戶編號 Client no. ：_____________________ 自我證明表格 –控權人Self-Certification Form – Controlling person (表格Form IR1457) 重要提示Important Notes ：  這是由控權人向申報財務機構提供的自我證明表格，以作自動交換財務帳戶資料用途。申報財務機構可把收集所得的資料交給稅務局， 稅務局會將資料轉交到另一稅務管轄區的稅務當局。This is a self-certification form provided by a controlling person to a reporting financial institution for the purpose of automatic exchange of financial account information. The data collected may be transmitted by the reporting financial institution to the Inland Revenue Department for transfer to the tax authority of another jurisdiction.  如控權人的稅務居民身分有所改變，應盡快將所有變更通知申報財務機構。A controlling person should report all changes in his/her tax residency status to the reporting financial institution.  除不適用或特別註明外，必須填寫這份表格所有部分。如這份表格上的空位不夠應用，可另紙填寫。在欄/部標有星號（* ）的項目為申報 財務機構須向稅務局申報的資料。All parts of the form must be completed (unless not applicable or otherwise specified). If space provided is insufficient,continue on additional sheet(s). Information in fields/parts marked with an asterisk (*) are required to be reported by the reporting financial institution to the Inland Revenue Department. 第一部: 實體帳戶持有人的身分識辨資料 Part 1 Identification of Controlling Person (1) 控權人的姓名 Name of Controlling 稱謂Title: ⃞先生Mr ⃞太太Mrs ⃞女士Ms ⃞小姐Miss ⃞其他Other _____________________________ person 姓氏 名字 中間名 Last Name First or Given Middle or Sur