Federal Free Printable Form 8957 (Rev. October 2015) for 2017 Federal Foreign Account Tax Compliance Act (FATCA) Registration

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Foreign Account Tax Compliance Act (FATCA) Registration
Form 8957 (Rev. October 2015)

Form 8957 (Rev. October 2015) Department of the Treasury Internal Revenue Service Foreign Account Tax Compliance Act (FATCA) Registration ▶ OMB No. 1545-2246 Information about Form 8957 and its separate instructions is at www.irs.gov/form8957. • 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 http://www.irs.gov/fatca. • The IRS strongly recommends that applicants register by accessing the online version of this form at http://www.irs.gov/fatca. The use of this paper form will take longer for the IRS to process and if any information 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 1 Financial Institution Registration 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 must provide the FATCA ID issued for such Member and provided by your Lead: Sponsoring Entity 2 3a b 4 Legal Name of the Financial Institution What is the Financial Institution's country/jurisdiction of residence for tax purposes? What is the Financial Institution's country/jurisdiction tax ID? Select the Financial Institution's FATCA classification in its country/jurisdiction of tax residence (check only one) Participating Financial Institution not covered by an IGA; or a Reporting Financial Institution under a Model 2 IGA Registered Deemed-Compliant Financial Institution (including a Reporting Financial Institution under a Model 1 IGA) Limited Financial Institution None of the above 5 Mailing Address of Financial Institution Country/Jurisdiction Address Line 1 Address Line 2 City For Paperwork Reduction Act Notice, see separate instructions. State/Province/Region ZIP/Postal Code Cat. No. 37778V Form 8957 (Rev. 10-2015) Form 8957 (Rev. 10-2015) 6 a Page 2 Indicate whether the Financial Institution has in effect a withholding agreement with the IRS to be treated as one of the following: 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 No c Withholding Foreign Trust (WT) Provide WT EIN: Does the Financial Institution intend to maintain its status as a WT? Yes No d Not applicable 7 Does the Financial Institution maintain a branch in a jurisdiction outside of its country/jurisdiction of tax residence? Yes (If “Yes,” complete lines 8, 9a, 9b, and 9c) No (If “No,” go to line 10) 8 Is the Financial Institution a tax resident of the United States or does it maintain a branch in the United States (other than the U.S. territories)? Yes Provide the U.S. EIN of the U.S. Financial Institution or U.S. branch: No 9a b List each jurisdiction (other than the United States) in which the Financial Institution maintains a branch. Also please list branches maintained in any of the U.S. territories. If none, leave blank and go to line 10. Is the branch a Limited Branch? Yes No c If the branch is currently covered by a QI agreement, does the Financial Institution intend to maintain QI status for that branch? Yes No Not applicable (Use additional sheets to add branches.) 10 FATCA Responsible Officer (RO) for the Financial Institution Business Title of RO Legal Name Last (Family) First (Given) Middle Country/Jurisdiction City Business Address Line 1 Business Address Line 2 Business Telephone Number State/Province/Region Business Fax Number ZIP/Postal Code Business Email Address of RO Form 8957 (Rev. 10-2015) Page 3 Form 8957 (Rev. 10-2015) 11a b The Financial Institution's RO will be a point of contact (POC) for the Financial Institution. In addition, the RO of a Financial Institution registering as a Lead of all or part of an Expanded Affiliated Group will be a POC for each Member of that group. Does the RO or an Authorizing Individual wish to designate one or more additional POCs for the Financial Institution? Yes (If “Yes,” complete line 11b) No (If “No,” go to line 12) This line 11b must be completed by the Financial Institution's RO or an Authorizing Individual. Upon entering the POC information below, checking the box that follows, and submitting this registration form, the RO or Authorizing Individual is providing the IRS with written authorization to release FATCA information to the POC. This authorization specifically includes authorization for the POC to complete this Form 8957: FATCA Registration, to take other FATCA-related actions, and to obtain access to the Financial Institution's tax information. Business Title of POC Legal Name of POC Last (Family) First (Given) Middle Country/Jurisdiction City Business Address Line 1 Business Address Line 2 Business Telephone Number State/Province/Region Business Fax Number ZIP/Postal Code Business Email Address of POC Five POCs are allowed per Financial Institution. Use additional sheets to add POCs. By checking this box, I, , as RO or Authorizing Individual for the Financial Institution, provide the authorization described above to the identified POCs listed in this line 11b. Once this authorization is granted, it is effective until revoked by either the Financial Institution or the POC. Part 2 12 Expanded Affiliated Group Lead Financial Institutions must read the instructions before completing Part 2. Provide the following for each Financial Institution member of the Expanded Affiliated Group Legal name of Member Financial Institution Country/Jurisdiction of residence for tax purposes Member type * * Enter one of the following: Participating Financial Institution not covered by an IGA; or a Reporting Financial Institution under a Model 2 IGA Registered Deemed-Compliant Financial institution (including a Reporting Financial Institution under a Model 1 IGA) Limited Financial Institution Form 8957 (Rev. 10-2015) Page 4 Form 8957 (Rev. 10-2015) Part 2 13a Expanded Affiliated Group (continued) Is the Financial Institution the Common Parent Entity of the Expanded Affiliated Group? Yes (If “Yes,” go to line 14) No (If “No,” complete line 13b) b Enter the Legal Name of the Expanded Affiliated Group’s Common Parent Entity. Also enter the FATCA ID (if known). Legal Name of the Common Parent Entity ▶ FATCA ID ▶ Part 3 14 Renewal of Agreement for QIs, WPs, or WTs Has QI/WP/WT's legal name changed since the effective date of its most recent QI/WP/WT agreement? Yes. Provide new legal business name Provide reason for name change Merger Liquidation Re-branding (name change only) No 15 Responsible Party Legal Name of Responsible Party Last (Family) First (Given) Middle Business Title Business Telephone Number Business Fax Number Business Email Address of Responsible Party Is the responsible party the same person listed as the RO for the Financial Institution? Yes No 16 Identify any private arrangement intermediary (PAI) contracts that are effective: Legal Name of PAI Country/Jurisdiction Address Line 1 Address Line 2 City State/Province/Region Email Address of PAI Part 4 ZIP/ Postal Code Use additional sheets to add more PAIs. SIGNATURE By checking this box, I, , certify that, to the best of my knowledge, the information submitted above is accurate and complete and I am authorized to agree that the Financial Institution (including its branches, if any) will comply with its FATCA obligations in accordance with the terms and conditions reflected in regulations, intergovernmental agreements, and other administrative guidance to the extent applicable to the Financial Institution based on its status in each jurisdiction in which it operates. Signature ▲ ▲ Sign Here I declare that I have examined this form including any accompanying statements, and to the best of my knowledge and belief, it is true, correct, and complete. Date Form 8957 (Rev. 10-2015)
Extracted from PDF file 2016-federal-form-8957.pdf, last modified December 1969

More about the Federal Form 8957 Other TY 2016

We last updated the Foreign Account Tax Compliance Act (FATCA) Registration in May 2017, so this is the latest version of Form 8957, fully updated for tax year 2016. You can download or print current or past-year PDFs of Form 8957 directly from TaxFormFinder. You can print other Federal tax forms here.

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Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 8957 from the Internal Revenue Service in May 2017.

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Historical Past-Year Versions of Federal Form 8957

We have a total of three past-year versions of Form 8957 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2016 Form 8957

Form 8957 (Rev. October 2015)

Foreign Account Tax Compliance Act (FATCA) Registration 2015 Form 8957

Form 8957 (Rev. October 2015)

Foreign Account Tax Compliance Act (FATCA) Registration 2013 Form 8957

Form 8957 (August 2013)


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