Vorlage (Abkommen en)

(1) a self-certification that the Account Holder is not a U.S.

citizen or resident for tax purposes (which may be on an IRS Form W-8 or other similar agreed form); and

(2) documentary evidence, as defined in paragraph VI.D of this Annex I, establishing the Account Holder’s non-U.S. status.

d) Where Account Holder information contains a currently

effective power of attorney or signatory authority granted to a person with a U.S. address, has an “in care of” address or “hold mail” address that is the sole address identified for the Account Holder, or has one or more U.S. telephone numbers (if a non-U.S. telephone number is also associated with the account), the Reporting Swiss

Financial Institution obtains or has previously reviewed and maintains a record of:

(1) a self-certification that the Account Holder is not a U.S. citizen or resident for tax purposes (which may be on an IRS Form W-8 or other similar agreed form); or

(2) documentary evidence, as defined in paragraph VI.D of this Annex I, establishing the Account Holder’s non-U.S. status.

C. Additional Procedures Applicable to Preexisting Individual Accounts That Are Lower Value Accounts

1. Review of Preexisting Individual Accounts that are Lower Value Accounts for U.S. indicia must be completed by December 31, 2015.

2. If there is a change of circumstances with respect to a Preexisting Individual Account that is a Lower Value Account that results in one or more U.S. indicia described in subparagraph B (1) of this section being associated with the account, then Reporting Swiss Financial Institution must treat the account as a U.S. Account unless subparagraph B (4) of this section applies.

3. Except for Depository Accounts described in subparagraph A (4) of this section, any Preexisting Individual Account that has been identified as a U.S. Account under this section shall be treated as a U.S. Account in all subsequent years, unless the Account Holder ceases to be a Specified U.S. Person.

D. Enhanced Review Procedures for Preexisting Individual Accounts With a Balance or Value That Exceeds $1,000,000 as of December 31, 2013, or December 31 of Any Subsequent Year (“High-Value Accounts”)

1. Electronic Record Search. The Reporting Swiss Financial Institution must review electronically searchable data maintained by the Reporting Swiss Financial Institution for any of the U.S. indicia identified in subparagraph B (1) of this section.