Self Certification

Individual Tax Residency Self-Certification Form

The Income Tax (Common Reporting Standard) Regulation, 2019 requires financial institutions to collect and report certain information on financial accounts of non-resident individuals by filling the Self-Certification Form. The Self-Certification Form is therefore provided by Lotus Capital Limited for the purpose of obtaining information for exchange with other reportable jurisdiction(s).

Please read carefully for the second section of the form

Complete the following table indicating (a) where you are resident for tax purposes and (b) your TIN for each country/jurisdiction indicated.

If you are tax resident in more than one country/jurisdiction, please fill as appropriate
If a TIN is unavailable, please provide the appropriate reason A, B or C where indicated below:

Reason A: The country/jurisdiction where I am resident for tax purposes does not issue TIN/equivalent number to its residents

Reason B: I am unable to obtain a TIN or equivalent number (Please explain why you are unable to obtain a TIN/equivalent number if you have selected this reason)

Reason C: TIN/equivalent number is not required. (Only select this reason if the domestic law of the relevant country/jurisdiction of residence does not require TIN to be disclosed)

Please read carefully for the third section of the form

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

Declaration and Consent

I acknowledge and agree that (a) the information contained in this form is collected and may be kept by LOTUS Capital Limited for the purpose of automatic exchange of financial account information, and (b) such information and information regarding me and any reportable account(s) may be reported by Lotus Capital Limited to the NIGERIA REVENUE SERVICE and exchanged with the tax authorities of another jurisdiction or jurisdictions in which you may be resident for tax purposes. I certify that I am the investor/ I am authorized to sign for the investor of the account to which this form relates. I undertake to advise LOTUS Capital limited of any change in circumstances which affects the tax residency status of the investor identified in Part 1 of this form or causes the information contained herein to become incorrect, and to provide LOTUS Capital limited with a suitably updated Self-Certification Form within 30 days of such change in circumstances.

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Please input your TIN or visit https://taxid.nrs.gov.ng/ to get your TIN