SIX SIS SA Adresse postale:
Brandschenkestrasse 47 Case postale
CH-8002 Zurich 1758
T +41 58 399 3111 CH-8021 Zurich
Formulaire 128
Demande d’ouverture, de mutation, de clôture de dépôt 10/2011
(Tient lieu de relevé de retenue à la source provisoire)
BP ID*: Contact*:
Société*: Téléphone*:
QI-EIN*: E-mail:
1. Veuillez exécuter les instructions suivantes* Pour l'utilisation SIX-SIS interne
uniquement
Task:_______________________
Choisissez l'instruction ici s.v.p. CIM _________ / CRM __________
Investors Domicile comme suit (Points 2. - 5., si applicables): Vollständigkeitsprüfung
Marché Unterschriftenprüfung
Datum/Visum:___________________
2. Type de dépôt* Steuerkategorieprüfung
Datum/Visum:___________________
Désignation: Choisissez le type ici s.v.p. Type -
Depoteröffnung
De-Linked
Eröffnungsauftrag CUMD
No. Du Dépôt: Vostro P:_______________________
3. Monnaie d'évaluation: (CHF par défaut) Vostro X:_______________________
CHF Linked
4. Référence de dépôt externe: Eröffnungsauftrag PNWM
Ext. Acc. Ref.:___________________
(veuillez indiquer la désignation choisie; optionnel)
Eröffnungsauftrag CUMD
5. Type d'assignation QI et catégorie d'imposition (cf. « Overview SCA tax categories »)* Vostro P:_______________________
Pour ce dépôt, nous agissons en tant que Nostro P:_______________________
Vostro X:_______________________
9
Choisissez le statut QI s.v.p.
Nostro X:_______________________
Spécifications: Choisissez les détails s.v.p. Datum/Visum:___________________
Taxation Category: T.C. Choisissez la catégorie d'imposition/marché s.v.p. Depotmutation CUMD
Datum/Visum:___________________
Formulaire requis: Requested Form Depotschliessung
Formulaires en annexe*: Positionsprüfung i.O.
De-Linked
Déclaration de non-Résidence (France) Dichiarazione (Italy) Schliessungsauftrag CUMD
Linked
Autres: Schliessungsauftrag PNWM
Veuillez trouver ci-joint les formulaires. Schliessungsauftrag CUMD
Datum/Visum:___________________
Nous confirmons que le formulaire W-8 IMY déjà remis est également valable pour ce
Bestätigung BP
dépôt.
Erl. Datum:_____________________
Visum:_________________________
Lieu / Date: Cachet de la société et signature:
* = Champs obligatoires
Nom de(s) la soussigné(e)s en majuscules:
Veuillez faxer une copie de ce formulaire au: +41 58 499 4223
Veuillez envoyer l'original du formulaire à: SIX SIS SA
Customer Master Data and Administration
Case postale 1758
CH-8021 Zurich
Pour toute question, veuillez appeler le numéro de téléphone: +41 58 399 4222
Adresse postale:
Case postale
1758
CH-8021 Zurich
Formulaire 128
10/2011
sk:_______________________
Vollständigkeitsprüfung
Unterschriftenprüfung
tum/Visum:___________________
Steuerkategorieprüfung
tum/Visum:___________________
Eröffnungsauftrag CUMD
stro P:_______________________
stro X:_______________________
Eröffnungsauftrag PNWM
. Acc. Ref.:___________________
Eröffnungsauftrag CUMD
stro P:_______________________
stro P:_______________________
stro X:_______________________
stro X:_______________________
tum/Visum:___________________
Depotmutation CUMD
tum/Visum:___________________
Depotschliessung
Schliessungsauftrag CUMD
Schliessungsauftrag PNWM
Schliessungsauftrag CUMD
tum/Visum:___________________
. Datum:_____________________
sum:_________________________
on
Auftragsart
Choisissez l'instruction ici s.v.p.
Ouverture d’un dépôt vostro (de-linked)
Ouverture d’un dépôt vostro (linked)
Clôture du dépôt
Changement du dépôt
SecLend Borrower Liability
SNB Extended Cover Vostro Account
Vostro Safe Custody Account for x-clear SFX
TCM Vostro Safe Custody Account
TCM Collateral Pool Vostro Account
Depot-Typ Code
Choisissez le type ici s.v.p. -
Ordinary 01
Lending 02
Collateral for external entities 03
Collateral 04
Custody Cover Account SNB 05
Borrower Liability 08
Collateral Custody account for CCP (irregular pledge) 09
Reinvestment 13
Restricted 14
Escrow 15
Tax exempt 16
Street name 17
Resident 18
SecLend Lender Loan 19
SecLend Borrower Liability 20
SNB Extended Cover Vostro Account 21
Vostro Safe Custody Account for x-clear SFX 22
23
Vostro Safe Custody Account for Unsecuritised Position(s)
TCM Vostro Safe Custody Account 24
TCM Collateral Pool Vostro Account 25
Evaluation Currency QI Status Description
CHF Choisissez le statut QI s.v.p.
1. QI with primary NRA withholding responsibility and with 1099
AUD reporting and backup withholding responsibility
2. QI with primary NRA withholding responsibility, but no 1099
CAD reporting and no backup withholding responsibility
3. QI without primary NRA withholding responsibility, but with
DKK 1099 reporting and backup withholding responsibility
4. QI without primary NRA withholding responsibility, no 1099
EUR reporting and no backup withholding responsibility
GBP 5. NQI Business Partners
HKD 6. Proprietorship positions
JPY 7. Resident positions
USD 8. Various (Special Tax Rate)
ZAR
9
#QI #QI Description #QI
9 9 Rien à choisir 9
1 1 QI with primary NRA withholding responsibility 1
2 2 NRA investors 2
3 2 US investors (linked account) 2
4 3 NRA income allocation 2
5 3 NRA asset allocation 2
6 3 US investors 3
7 4 NRA income allocation 3
8 4 NRA asset allocation 3
4 US investors (linked account) 3
5 NQI Business Partners - non-US securities 3
5 NQI US securities for NRA disclosed 3
5 NQI US securities for US investors 3
6 NRA investors (must be documented) 3
7 Resident client(s) 3
8 Special Tax Rate - to be defined by SIS 3
3
3
3
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
6
6
6
6
7
7
7
7
8
Auswahlliste Details Auswahlliste Taxation Category
Choisissez les détails s.v.p.
9 Rien à choisir 9
Description
Rien à choisir
QI with primary NRA withholding responsibility
NRA investors
US investors (linked account)
US investors (linked account)
US investors (linked account)
NRA income allocation
NRA income allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
US investors
NRA income allocation
NRA income allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
NRA asset allocation
US investors (linked account)
US investors (linked account)
US investors (linked account)
NQI Business Partners - non-US securities
NQI Business Partners - non-US securities
NQI US securities for NRA disclosed
NQI US securities for NRA disclosed
NQI US securities for NRA disclosed
NQI US securities for NRA disclosed
NQI US securities for NRA disclosed
NQI US securities for NRA disclosed
NQI US securities for NRA disclosed
NQI US securities for NRA disclosed
NQI US securities for NRA disclosed
NQI US securities for NRA disclosed
NQI US securities for NRA disclosed
NQI US securities for NRA disclosed
NQI US securities for NRA disclosed
NQI US securities for NRA disclosed
NQI US securities for NRA disclosed
NQI US securities for NRA disclosed
NQI US securities for NRA disclosed
NQI US securities for US investors
NQI US securities for US investors
NRA investors (must be documented)
NRA investors (must be documented)
NRA investors (must be documented)
NRA investors (must be documented)
Resident client(s)
Resident client(s)
Resident client(s)
Resident client(s)
Special Tax Rate - to be defined by SIS
Auswahlliste Taxation Category
Choisissez les détails s.v.p.
Detailed Description
-
QI with primary NRA withholding responsibility
QI with primary NRA withholding responsibility
W9 non-exempt US a/c (omnibus or segregated)
Undisclosed/undocumented non-exempt US a/c (omnibus)
Exempt US a/c (omnibus)
Swiss Bank Business Partners
Non-Swiss Business Partners
US non-treaty account 30/30
US treaty 30/0
US treaty 25/17.5
US treaty 25/15
US treaty 20/15
US treaty 15/15
US treaty 15/12.5
US treaty 15/12
US treaty 15/10
US treaty 15/5
US treaty 15/0
US treaty 10/15
US treaty 10/10
US treaty 10/0
Exempt account (govt/supernat/charities/US exempt etc.)
Exempt Account (foreign private foundation)
Undocumented non-US a/c
Swiss QI STRUSA a/c 15/30
Special _______________________________________
Exempt account (govt/supernat/charities/US exempt etc.)
Swiss Bank Business Partners
Non-Swiss Business Partners
US non-treaty account 30/30
US treaty 30/0
US treaty 25/17.5
US treaty 25/15
US treaty 20/15
US treaty 15/15
US treaty 15/12.5
US treaty 15/12
US treaty 15/10
US treaty 15/5
US treaty 15/0
US treaty 10/15
US treaty 10/10
US treaty 10/0
Exempt account (govt/supernat/charities/US exempt etc.)
Exempt Account (foreign private foundation)
Undocumented non-US a/c
Swiss QI STRUSA a/c 15/30
Special _______________________________________
W9 non-exempt US a/c (omnibus or segregated)
Undisclosed/undocumented non-exempt US a/c (omnibus)
Exempt US a/c (omnibus)
NQI non-Swiss Business Partners
NQI Swiss Business Partners
US non-treaty account 30/30
US treaty 30/0
US treaty 25/17.5
US treaty 25/15
US treaty 20/15
US treaty 15/15
US treaty 15/12.5
US treaty 15/12
US treaty 15/10
US treaty 15/5
US treaty 15/0
US treaty 10/15
US treaty 10/10
US treaty 10/0
Exempt account (govt/supernat/charities/US exempt etc.)
Exempt Account (foreign private foundation)
Special _______________________________________
W9 non-exempt US a/c (omnibus or segregated)
Exempt US a/c (omnibus)
Swiss & non-Swiss Business Partners -own positions treaty a/c 15/0
Swiss Business Partners - own positions with STRUSA 15/30
Business Partners own positions exempt 0/0
Business Partners non-treaty 30/30
France
Canada
Belgium
other:
Choisissez la catégorie d'imposition/marché s.v.p.
Taxation Category Required form Listenberechnung
- -
37 W-8IMY (9a, b, c)
37 W-8IMY (9a, b)
34 W-8IMY (9a, b)
35 W-8IMY (9a, b)
36 W-8IMY (9a, b)
1 W-8IMY (9a, c)
3 W-8IMY (9a, c)
11 W-8IMY (9a, c)
12 W-8IMY (9a, c)
13 W-8IMY (9a, c)
14 W-8IMY (9a, c)
15 W-8IMY (9a, c)
16 W-8IMY (9a, c)
17 W-8IMY (9a, c)
18 W-8IMY (9a, c)
19 W-8IMY (9a, c)
20 W-8IMY (9a, c)
21 W-8IMY (9a, c)
22 W-8IMY (9a, c)
23 W-8IMY (9a, c)
24 W-8IMY (9a, c)
31 W-8IMY (9a, c)
32 W-8IMY (9a, c)
33 W-8IMY (9a, c)
38 W-8IMY (9a, c)
__ ____________________
31 W-8IMY (9a, c)
1 W-8IMY (9a)
3 W-8IMY (9a)
11 W-8IMY (9a)
12 W-8IMY (9a)
13 W-8IMY (9a)
14 W-8IMY (9a)
15 W-8IMY (9a)
16 W-8IMY (9a)
17 W-8IMY (9a)
18 W-8IMY (9a)
19 W-8IMY (9a)
20 W-8IMY (9a)
21 W-8IMY (9a)
22 W-8IMY (9a)
23 W-8IMY (9a)
24 W-8IMY (9a)
31 W-8IMY (9a)
32 W-8IMY (9a)
33 W-8IMY (9a)
38 W-8IMY (9a)
__ ____________________
34 W-8IMY (9a) plus W-9
35 W-8IMY (9a) (no W-9 submitted)
36 W-8IMY (9a) plus W-9
41 W-8IMY NQI (10a)
42 W-8IMY NQI (10a)
11 W-8IMY NQI (10b) plus BEN/EXP
12 W-8IMY NQI (10b) plus BEN/EXP
13 W-8IMY NQI (10b) plus BEN/EXP
14 W-8IMY NQI (10b) plus BEN/EXP
15 W-8IMY NQI (10b) plus BEN/EXP
16 W-8IMY NQI (10b) plus BEN/EXP
17 W-8IMY NQI (10b) plus BEN/EXP
18 W-8IMY NQI (10b) plus BEN/EXP
19 W-8IMY NQI (10b) plus BEN/EXP
20 W-8IMY NQI (10b) plus BEN/EXP
21 W-8IMY NQI (10b) plus BEN/EXP
22 W-8IMY NQI (10b) plus BEN/EXP
23 W-8IMY NQI (10b) plus BEN/EXP
24 W-8IMY NQI (10b) plus BEN/EXP
31 W-8IMY NQI (10b) plus BEN/EXP
32 W-8IMY NQI (10b) plus BEN/EXP
__ ____________________
34 W-8IMY NQI (10b) plus W-9
36 W-8IMY NQI (10b) plus W-9
39 W-8 BEN
40 W-8 BEN
43 W-8 EXP
44 W-8 BEN
6 W-8IMY (9a, c) + No additional Forms required
6 W-8IMY (9a, c) + Resident Décleration
6 W-8IMY (9a, c) + No additional Forms required
6
__
T.C. Requested Form
Listenberechnung