CRS & FATCA Self Certication Form [individual]

Declarations and Signature

I/We authorize Sterling to disclose relevant account and/or personal information to the us tax authorities and other relevant tax authorities of jurisdictions where I am tax resident for the purpose of Sterling complying with its obligations under the United States(US) Foreign Account Tax Compliance Act ("FATCA") and/or Common Reporting Standard(CRS). I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. If the information provided in this form changes, I undertake to provide Sterling with an updated self -certification and declaration within 30 days of such change.

I/We the undersigned applicant, warrant that the above information supplied by me/us is true and correct. I/We will undertake to fully cooperate with Sterling to ensure it meets its obligations under FATCA and CRS in connection with my/our account.

I/We will indemnify and hold harmless Sterling from any loss, action, cost, expense (including, but not limited to sums paid in settlement of claims, reasonable attorneys' and consultant fees, and expert fees), claim, damages, or liability which arises or is incurred by Sterling Bank Plc as a result of false information or error in the information provided to the Bank, our choice of account or in discharging its obligations under FATCA and CRS and/or as a result of disclosures to the United States(US) tax authorities and/or any other jurisdictions under the AEOI regime.