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Version 1.1.14_26-09-2019
Information
Request account
Submit the information below
Responsible for exchange of information
The person responsible for data delivery for a FATCA liable institute should be the same person as the
responsible officer
entered in the FATCA registration
First name contact person: *
Contact person last name: *
E-mail address: *
Repeat e-mail address: *
Telephone number: *
Financial institution
TIN:
My financial institution is not liable to pay tax in this jurisdiction and does not have a TIN
GIIN:
My financial institution is not obliged to deliver FATCA data to the IRS and does not have a GIIN-number
Formal/Legal name: *
Tradename:
Proof of FATCA registration:
Confirmation of the IRS FATCA registration including responsible officer's details (file type pdf, doc, docx, png, jpg or bmp, max. 15MB)
Copy of Certificate of Incorporation (MCIL): *
File type pdf, doc, docx, png, jpg or bmp, max. 15MB
Responsible person's ID: *
File type pdf, doc, docx, png, jpg or bmp, max. 15MB
Login credentials
Username: *
Password: *
Password should be at least 8 characters long and contain at least one capital letter, one lower case letter, one number and one special sign (!@#$%^&*()).
Confirm password: *
Preferred communication language: *
Dutch
English
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