Self Certification Form

Please indicate where the Account Holder is tax resident and provide the Taxpayer Identification Number (TIN) for each country/jurisdiction. If tax resident in more than three countries/jurisdictions, please use a separate sheet.

Documentary Evidence of the TIN should be provided.

I understand that the information supplied by me is covered by the full provisions of the terms and conditions governing the Account Holder's relationship with SFS Capital Nigeria Limited setting out how the Company may use and share the information supplied by me.

I acknowledge and agree that (a) the information contained in this form is collected and may be kept by the Company for the purpose of automatic exchange of financial account information, and (b) such information and information regarding the account holder and any reportable account(s) may be reported by the Company to the Federal Inland Revenue Service (FIRS) and exchanged with the tax authorities of another jurisdiction or jurisdictions in which the account holder may be resident for tax purposes.

I certify that I am the account holder / I am authorized to sign for the account holder of all the account(s) to which this form relates.

I undertake to advise SFS Capital Nigeria Limited within 30 days of any change in circumstances which affects the tax residency status of the individual identified in Part 1 of this form or causes the information contained herein to become incorrect or incomplete, and to provide the Company with a suitably updated self-certification and Declaration within 30 days of such change in circumstances.

I declare that the information given and statements made in this form are, to the best of my knowledge and belief, true, correct and complete.