[PDF] Form 8957 (Rev. June 2018) Form 8957. (Rev. June 2018).





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Form 8957 (Rev. June 2018)

Form 8957. (Rev. June 2018). Department of the Treasury. Internal Revenue Service. Foreign Account Tax Compliance Act (FATCA) Registration.

Form 8957

(Rev. June 2018)

Department of the Treasury

Internal Revenue Service

Foreign Account Tax Compliance Act (FATCA) Registration Go to www.irs.gov/Form8957 for instructions and the latest information.

OMB No. 1545-2246

• All applicants must complete Part 1. • This form will not be processed if it is not signed. • DO NOT fill out this form if you have begun registering at www.irs.gov/FATCA

The IRS strongly recommends that applicants register by accessing the online version of this form at www.irs.gov/FATCA. The use

of this paper form will take longer for the IRS to process and if any in formation is missing or incomplete the delay in registration may be significant.

This form should be mailed to:

FATCA, Stop 6099 AUSC

3651 South IH 35

Austin, Texas 78741 Part 1 Financial Institution Registration

1 Select Financial Institution Type (check only one)Single (not a member of an Expanded Affiliated Group)

Lead of an Expanded Affiliated Group

Member (not Lead) of an Expanded Affiliated Group. If a Member, you mu st provide the FATCA ID issued for such Member and provided by your Lead:

Sponsoring Entity

2

Legal Name of the Financial Institution

3 aWhat is the Financial Institution's country/jurisdiction of residence

for tax purposes? b What is the Financial Institution's country/jurisdiction tax ID?

4Select the Financial Institution"s FATCA classification in its country/jurisdiction of tax residence (check only one)

Direct Reporting NFFE

Participating FFI, including a Reporting Financial Institution under a M odel 2 IGA

Registered Deemed-Compliant FFI that is a Local FFIRegistered Deemed-Compliant FFI that is a Non-Reporting Member of a PFFI

Group Registered Deemed-Compliant FFI that is a Qualified Collective Investmen t Vehicle Registered Deemed-Compliant FFI that is a Qualified Credit Card Issuer o r Servicer Registered Deemed-Compliant FFI that is a Restricted Fund Reporting Financial Institution under a Model 1 IGA Sponsoring Entity of Sponsored Direct Reporting NFFEs Sponsoring Entity of Sponsored FFIs Sponsoring Entity of Sponsored FFIs and Sponsored Direct Reporting NFFEs

Trustee of a Trustee-Documented Trust

U.S. Financial Institution

5Mailing Address of Financial Institution

Country/Jurisdiction

Address Line 1

Address Line 2CityState/Province/Region ZIP/Postal Code

For Paperwork Reduction Act Notice, see separate instructions.Cat. No. 37778V Form 8957 (Rev. 6-2018)

Form 8957 (Rev. 6-2018)

Page 2

6Indicate whether the Financial Institution has in effect a withholding agreement with the IRS to be treated as one of the following:

a

Qualified Intermediary (QI)

Provide QI EIN:

Does the Financial Institution intend to maintain its status as a QI? Yes No b

Withholding Foreign Partnership (WP)

Provide WP EIN:

Does the Financial Institution intend to maintain its status as a WP? Yes Noquotesdbs_dbs7.pdfusesText_5
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