自我证明表格–实体香港适用-AIA.PDF

AIA International Limited (Incorporated in Bermuda with limited liability) SELF-CERTIFICATION FORM – ENTITY (FOR HONG KONG) 自我證明表格– 實體(香港適用) Policy Number(s) 保單號碼: O6652016 Important Notes : • This is a self-certification form provided by an account holder 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 . • An account holder should report all changes in his / her tax residency status to the reporting financial institution. • 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. 重要提示： • 這是由帳戶持有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。 • 如帳戶持有人的稅務居民身份有所改變，應盡快將所有變更通知申報財務機構。 • 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。 PART 1 IDENTIFICATION OF ENTITY ACCOUNT HOLDER 第 1 部 實體帳戶持有人的身份識辨資料 (For joint or multiple account holders, complete a separate form for each entity account holder.) (對於聯名帳戶或多人聯名帳戶，每名實體帳戶持有人須分別填寫一份表格) (1) Legal Name of Entity or Branch* 實體或分支機構的法定名稱* (2) Jurisdiction of Incorporation or Organisation 實體成立為法團或