{"id":2035,"title":"FATCA/ CRS form for Individual","purpose":"service","insurer":{"slug":"star-union-dai-ichi-life-insurance","name":"Star Union Dai-Ichi Life Insurance Company Limited"},"source_pdf":"https://dxwkpt4djlxwl.cloudfront.net/NRI_FATCA_CRS_Form_for_Individuals_0dfff73bcf.pdf","sha256":"390c2ff67fe4d04fd078d9e7a3deffe80967628c9f52706e120e5d6259c988ba","pages":5,"collected":"2026-10-20","instructions":{"about":"This form is for individual account holders to provide information required for compliance with FATCA and CRS regulations related to tax residency and financial account reporting. It is filled by the life assured or proposer.","notes":["All fields are mandatory and must not be left blank","TIN or functional equivalent must be provided if issued by the tax residence country","If no TIN is available, provide an explanation and attach it","Provide documentary evidence to cure FATCA/CRS indicia as per the list on page 5","Acceptable documentary evidence includes certificate of residence or valid government issued ID","Use separate form for each individual account holder if joint or multiple holders","Signature or thumb impression must be attested by advisor/intermediary or person of standing"],"title":"FATCA/ CRS form for Individual","submit":{"to":"","how":"","address":""},"purpose":"service","sections":[{"title":"Personal and Residency Information","fields":[{"help":"Enter the full name of the life assured","type":"text","label":"Life Assured Name","options":[],"required":true,"pdf_field":""},{"help":"Enter the application or policy number","type":"text","label":"Application No/ Policy No","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Are you a resident of a jurisdiction outside India?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide the country name(s) if resident outside India","type":"text","label":"If yes, please provide the name of your jurisdiction(s) of residence Name of the country","options":[],"required":true,"pdf_field":""},{"help":"Select one option","type":"choice","label":"Tax residence declaration - tick any one as applicable to you?","options":["I am a tax resident of India and not a resident of any other country","I am tax resident of the country/ies mentioned in the table below"],"required":true,"pdf_field":""},{"help":"List all countries where you are tax resident","type":"table","label":"Country#","options":[],"required":true,"pdf_field":""},{"help":"Provide Tax ID number or functional equivalent for each country","type":"table","label":"Tax Identification Number\"","options":[],"required":true,"pdf_field":""},{"help":"Specify type of tax ID","type":"table","label":"Identification Type (TIN or Other\" please specify)","options":[],"required":true,"pdf_field":""},{"help":"Enter your city of birth","type":"text","label":"City of birth","options":[],"required":true,"pdf_field":""},{"help":"Enter your country of birth","type":"text","label":"Country of Birth","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Do you have a current mailing address or residence address (including a Post Office Box) in a jurisdiction(s) outside India?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide address line 1","type":"text","label":"If answer to the question 5 is 'Yes' then provide the details; Address Line 1","options":[],"required":true,"pdf_field":""},{"help":"Provide address line 2 if applicable","type":"text","label":"Address Line 2","options":[],"required":false,"pdf_field":""},{"help":"Provide city or town","type":"text","label":"City/Town","options":[],"required":true,"pdf_field":""},{"help":"Provide state if applicable","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Provide country name","type":"text","label":"Country","options":[],"required":true,"pdf_field":""},{"help":"Provide postal code if applicable","type":"text","label":"Postal Code","options":[],"required":false,"pdf_field":""},{"help":"Provide PIN code if applicable","type":"text","label":"PIN Code","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Do you have any address (Current /permanent) with a 'hold mail' or 'in care of' address in a jurisdiction(s) outside India?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide address line 1","type":"text","label":"If answer to the question 6 is 'Yes' then provide the details; Address Line 1","options":[],"required":true,"pdf_field":""},{"help":"Provide address line 2 if applicable","type":"text","label":"Address Line 2","options":[],"required":false,"pdf_field":""},{"help":"Provide city or town","type":"text","label":"City/Town","options":[],"required":true,"pdf_field":""},{"help":"Provide state if applicable","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Provide country name","type":"text","label":"Country","options":[],"required":true,"pdf_field":""},{"help":"Provide postal code if applicable","type":"text","label":"Postal Code","options":[],"required":false,"pdf_field":""},{"help":"Provide PIN code if applicable","type":"text","label":"PIN Code","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Do you have a telephone number outside India?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide telephone number with country code","type":"text","label":"If answer to the question 7 in 'Yes' then please provide the details along with country code of the country; Phone No. 1","options":[],"required":true,"pdf_field":""},{"help":"Provide additional telephone number if any","type":"text","label":"Phone No. 2","options":[],"required":false,"pdf_field":""},{"help":"Provide additional telephone number if any","type":"text","label":"Phone No. 3","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Is there a 'Power of Attorney (POA)' or 'signatory authority (SA)' granted to a person with an address in jurisdiction outside India?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide name of POA or SA holder","type":"text","label":"If answer to the above question 8 is 'Yes', then please answer the following; Name and Address of the person to whom the POA or SA is granted Name","options":[],"required":true,"pdf_field":""},{"help":"Provide address line 1","type":"text","label":"Address Line 1","options":[],"required":true,"pdf_field":""},{"help":"Provide address line 2 if applicable","type":"text","label":"Address Line 2","options":[],"required":false,"pdf_field":""},{"help":"Provide city or town","type":"text","label":"City/Town","options":[],"required":true,"pdf_field":""},{"help":"Provide state if applicable","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Provide country name","type":"text","label":"Country","options":[],"required":true,"pdf_field":""},{"help":"Provide postal code if applicable","type":"text","label":"Postal Code","options":[],"required":false,"pdf_field":""},{"help":"Provide PIN code if applicable","type":"text","label":"PIN Code","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Whether POA or SA is currently effective?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide validity period of POA or SA","type":"text","label":"If answer to the above question (ii) is 'Yes' then please mention the time up to which the POA or SA is valid and effective","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Are there any standing instructions of funds transfer into any of other account maintained in a jurisdiction outside India?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide account number","type":"text","label":"If answer to the question 9 is 'Yes', please provide the details of the account holder (Name, account number and bank details) Account number","options":[],"required":true,"pdf_field":""},{"help":"Provide bank name","type":"text","label":"Name and Address of the Bank (including country) Name","options":[],"required":true,"pdf_field":""},{"help":"Provide bank address line 1","type":"text","label":"Address Line 1","options":[],"required":true,"pdf_field":""},{"help":"Provide bank address line 2 if applicable","type":"text","label":"Address Line 2","options":[],"required":false,"pdf_field":""},{"help":"Provide bank city or town","type":"text","label":"City/Town","options":[],"required":true,"pdf_field":""},{"help":"Provide bank state if applicable","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Provide bank country","type":"text","label":"Country","options":[],"required":true,"pdf_field":""},{"help":"Provide bank postal code if applicable","type":"text","label":"Postal Code","options":[],"required":false,"pdf_field":""},{"help":"Provide bank PIN code if applicable","type":"text","label":"PIN Code","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Do you have any other policy with Star Union Dai-ichi Life Insurance?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide policy number if applicable","type":"text","label":"If yes, provide the policy number","options":[],"required":false,"pdf_field":""}],"filled_by":"life assured / proposer"},{"title":"Declaration and Signature","fields":[{"help":"Enter date and place of signing","type":"text","label":"Date & Place","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of Proposer/ Payer","options":[],"required":true,"pdf_field":""},{"help":"Declarant to sign and provide name if proposer signs in vernacular or thumb impression","type":"signature","label":"Declaration In case Proposer signs In Vernacular / Uses Thumb Impression: Name and Signature of Declarant","options":[],"required":false,"pdf_field":""},{"help":"Date and place of declarant's signature","type":"text","label":"Date & Place","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer / payer"}],"deadlines":["Provide updated Self-Certification form within 30 days of any change in circumstances"],"applies_to":"individual account holders under Star Union Dai-ichi Life Insurance policies","attachments":["Proof of employment and income in the country of current residence","Documents as mentioned under Notes on page 4 for curing FATCA/CRS indicia","Self-certification if no TIN is available or issued","Documentary evidence such as certificate of residence or valid government issued ID"],"declarations":["I declare that the answers given are true and no material information is withheld","This questionnaire forms part of the life assurance proposal","I am not restricted or prohibited from proposing for this policy under any country's laws","I am responsible for fulfilling any legal, tax or financial obligations arising from this policy","I will promptly advise the company of any changes affecting the information provided","The company may report details to tax authorities or close/suspend policies as required","Information provided is not legal, accounting or tax advice"],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/star-union-dai-ichi-life-insurance/2035-fatca-crs-form-for-individual"}