税务居民身份自我证明表格–个人.PDF

致: 中银集团人寿保险有限公司 香港太古城英皇道1111 号太古城中心第1 期13 楼 To: BOC Group Life Assurance Company Limited 13/F, Cityplaza One, 1111 Kings Road, Taikoo Shing, Hong Kong 税务居民身份自我证明表格– 个人 Self-Certification Form for Tax Residency - Individual 重要提示： Important Notes: 1. 这是由账户持有人(下称「您」) 向中银集团人寿保险有限公司 (下称「本公司」或「中银人寿」) 提供的自我证明表格。本公司可根据i) 美国 「海 外账户税收合规法案」(“FATCA”)把您的资料提交予美国国税局；及/或ii) 《2016 年税务(修订)(第3 号)条例》及其后的相关修订条例，把收集所得 的资料交给香港政府税务局( 「税务局」) ，税务局会将资料转交到另一税务管辖区的税务当局。需提交的数据为您于本公司的保单记录及本表格 收集所得的数据，当中包括姓名、地址、出生日期、出生地、居留司法管辖区、税务编号及保单数据(包括保单号码及保单价值数据)等。 This is a self-certification form provided by an account holder (“you”) to BOC Group Life Assurance Company Limited (“the Company” or “BOC Life”). Your information may be transmitted by the Company to i) the U.S. Internal Revenue Service in accordance with United States Government’s Foreign Account Tax Compliance Act (“FATCA”); and/or ii) to the Inland Revenue Department of Hong Kong Government (“IRD”) in accordance with the Inland Revenue (Amendment) (No. 3) Ordinance 2016 and the subsequent relevant amendment ordinance for transfer to the tax authority of another jurisdiction (s). Transmitted data would be your policy information recorded in the Company and the information collected from this form, which includes your name, address, date and place of birth, jurisdiction of residence, taxpayer identification number (TIN) and policy information (including policy number and policy account value information), etc. 2. 如您的税务居民身份有所改变，请于改变后30 日内重新填写自我证明表格并交回本公司。本公司将以您最新签署的自我证明表格为准。此表格中 所载数据只会在本公司完成相关内部处理及审核程序后方能生效。 When there is any change of your tax residency, please complete self-certifi