Self-certification [Fill as an Individual]

Common Reporting Standard/Automatic Exchange of Information/Foreign Account Tax Compliance Act

The Automatic Exchange of Information (AEOI) regime is based on Common Reporting Standard (CRS), an internationally agreed Standard developed by the Organization of Economic Cooperation and Development (OECD) to combat tax evasion.

Sterling Bank Plc (Sterling) must comply with the relevant AEOI requirements in all jurisdictions in which the Bank operates.

In order to fulfill the AEOI requirements, Sterling Bank Plc must collect certain information and /or documentation from customers to establish their tax authorities in other countries or jurisdictions, in accordance with the applicable law.

In addition, the United States (U.S.) Foreign Account Tax Compliance Act (FATCA) requires Financial Institutions to collect and report tax related information on accounts held by U.S. persons.

Please visit www.firs.gov.ng; www.irs.gov/fatca and www.oecd.org

Branch Name

Account Name

Account Number

Phone number Number

Title

Surname

Firstname

Middlename

Residential address line 1

Residential Address line 2

City of birth

Country of birth

Please complete the following indicating;

Where the Account Holder is tax resident
The Account Holder's TIN for each Country/Jurisdiction indicated.

Please note that a TIN is a combination of letters and/or numbers assigned to the individual by the government of their country of residence, or its tax authorities, which is used to identify the individual for the purposes of collecting taxes. In some countries this may be a number that is specifically referred to as a TIN, while other countries may use other numbers such as (social security numbers) to identify their residents for tax purposes.

Kindly note that TIN/ is mandatory if you are non-resident in Nigeria, and where this is provided by the foreign jurisdiction of residence.

Country or Jurisdiction of Tax Residence

Tax Identification Number (TIN))

Reason for TIN unavailable

Country or Jurisdiction of Tax Residence

Tax Identification Number (TIN))

Reason for TIN unavailable

Country or Jurisdiction of Tax Residence

Tax Identification Number (TIN))

Reason for TIN unavailable

Declarations and Signature

I/We authorize Sterling to disclose relevant account and/or personal information to the us tax authorities and other relevant tax authorities of jurisdictions where I am tax resident for the purpose of Sterling complying with its obligations under the United States(US) Foreign Account Tax Compliance Act ("FATCA") and/or Common Reporting Standard(CRS). I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. If the information provided in this form changes, I undertake to provide Sterling with an updated self -certification and declaration within 30 days of such change.

I/We the undersigned applicant, warrant that the above information supplied by me/us is true and correct. I/We will undertake to fully cooperate with Sterling to ensure it meets its obligations under FATCA and CRS in connection with my/our account.

I/We will indemnify and hold harmless Sterling from any loss, action, cost, expense (including, but not limited to sums paid in settlement of claims, reasonable attorneys' and consultant fees, and expert fees), claim, damages, or liability which arises or is incurred by Sterling Bank Plc as a result of false information or error in the information provided to the Bank, our choice of account or in discharging its obligations under FATCA and CRS and/or as a result of disclosures to the United States(US) tax authorities and/or any other jurisdictions under the AEOI regime.

Full Name

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Date

If you have signed this form on behalf of the account holder please complete below

Capacity

Full Name

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Address

Position	Username	Points
1st	yuyu.odukoyas ^FB	100
2nd	jo.bug ^IG	92
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