Bank account opening

First Name

Surname

Address Line 1

Address Line 2

Provincec /State/Country

Postal Code / Zip Code

City / Town

Country

Date of Birth

Confirm

I am only Tax Resident in the country of account opening

I have included below all countries in which I am Tax Resident (other than the country of account opening).

Country of Tax Residence

Taxpayer Identification Number (TIN)

Reason Code

Explanation

1. I am the Account Holder and / or authorised to sign / disclose for the Account Holder.
2. I have consulted an Independent advisor where necessary and acknowledge that Wanfuteng Bank Ltd has not provided any advice.
3. I will notify Wanfuteng Bank Ltd of changes of any information (including TIN Changes) within 30 days of the change occuring and,
where required, will provide Wanfuteng Bank Ltd with a new Self-Certification.
4. I have attached all relevant documents (eg. Power of Attorney)
5. I have provided true, correct and complete information.
6. I will provide Wanfuteng Bank Ltd with any additional information and/or documentation as requested.
7. I understand that provision of false, inaccurate or incomplete information may constitute an offence(s) and penalties may apply

Name

Date

Signature

Note: If you are not the Account Holder please indicate the capacity in which you are signing the form. If signing
under a power of attorney please also attach a certified copy of the power of attorney.