個人FATCA身分別辨識聲明書
FATCA Status Identification Certification (For Individual Client)
客戶是否具有美國公民或稅務居民身分？
Does a client hold U.S citizenship or resident alien for tax purposes status?
□是 Yes
□否 No
註1：美國公民或稅務居民係指具有美國國籍者(持有美國護照)、持有綠卡者，或當年度入境美國並停留超過183天，或者當年度入境並在美國待超過31天，同時滿足所謂的『前3年審核期』的計算超過183天。
『前3年審核期』係以報稅年度及前二年在美居留天數「加權」計算，當年度在美國實際居留天數x 1 + 前一年度在美國實際居留天數x 1/3 + 前二年度在美國實際居留天數x 1/6，若總天數大於（或等於）183天，該客戶即為美國稅務居民
U.S citizen or resident alien is 
"Any person who holds U.S citizenship (U.S passport holder) or green card holder, or "
"Any person who physically presents in the United States for a total of 183 days or more during the calendar year, or"
"Any person who physically presents in the United States for a total of 31 days or more during the calendar year, and 183 days or more during the 3-year period that includes the current year and the 2 years immediately before that , counting:"
"All the days you were present in the current year, and"
"1/3 of the days you were present in the first year before the current year, and"
1/6 of the days you were present in the second year before the current year.
註2：若客戶聲明非具有美國公民或稅務居民身分，惟開戶個人資料之搜尋結果具有美國指標，將後續向客戶徵提身分證明文件。
"If a client certified that he/she does not hold U.S citizenship or resident alien status for tax purposes, only that the results of personal account profile searching have indicated with U.S indicia. In this case, related ID documentary will be requested from the client later on. "
註3：美國指標搜尋與應徵提之身分證明文件對應：
(1)美國公民或居留權：W-8-BEN及護照/身分證
(2)美國出生地：護照/身分證及喪失美國國籍證明 或 W-8-BEN及護照/身分證及書面聲明(說明放棄國籍或於出生時未取得美國公民權之原因)
(3)美國居住及郵寄地址：W-8-BEN及護照/身分證
(4)美國電話：W-8-BEN及護照/身分證
(5)常行指示匯款到美國帳戶：W-8-BEN及護照/身分證
(6)受託人具有美國地址：W-8-BEN或護照/身分證
(7)僅留有轉信或代收郵寄之美國地址：W-8-BEN或護照/身分證
U.S indicia and requested ID documentary matching:
(1)U.S citizen or U.S resident: W-8BEN and passport/ID 
(2)U.S place of birth: passport/ID and Individual’s Certificate of Loss of Nationality of the United States or W-8BEN and passport/ID and Written Explanation ( reasonable explanation of renunciation of U.S citizenship or failure of obtaining U.S citizenship at birth)
(3)U.S residence address and U.S mailing address: W-BEN and passport/ID
(4)U.S phone number: W-8BEN and passport/ID
(5)Standing instructions: W-8BEN and passport/ID
(6)A power of attorney with a U.S. address: W-8BEN or passport/ID
(7)An “in-care-of” address or “hold mail” address t: W-8BEN or passport/ID
上述內容均屬事實，本人同意應臺銀綜合證券之請求提供必要相關文件以佐證，如有不實願負一切法律責任，且若日後遇有情況變更情形應於90天內主動告知臺銀綜合證券。