TAX COMPLIANCE - INTERNATIONAL EXCHANGE OFINFORMATION AGREEMENT ENTITY SELF-CERTIFICATION FORM

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The Mauritius Commercial Bank Ltd.9-15 Sir William Newton Street, Port Louis, Republic of Mauritius T: +230 202 6060 F: +230 208 7054 E: contact@mcb.muSWIFT Code MCBLMUMU BRN: C07000934 www.mcb.mu

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This form can be filled in on a computer; alternatively please print and complete fields below in CAPITAL letters using black ink and tick () where appropriate.

2. Tax Residency InformationPart (1) – Financial Institutions (FI) [FATCA Requirement]

2.1.WhichFIdescriptionappliestoyourentity/organisation?

ParticipatingForeignFinancialInstitution RegisteredDeemedCompliantFinancialInstitution

2.2.Whatisyourentity’s/organisationGIIN? . . .Please fill section 3 in case your entity’s/organisation GIIN is unavailable.

2.3. Howdoyoudescribeyourentity/organisation?

AParticipatingFinancialInstitutioninanIGAandhasnotyetobtainedaGIIN.

IntendstoapplyforaGIIN.

AnExemptBeneficialOwner. ADeemedCertifiedCompliantFinancialInstitution.

AnOwnerDocumentedFinancialInstitution. ANon-ParticipatingForeignFinancialInstitution.

CRS

2.4. Howdoyoudescribeyourentity/organisation?

DepositoryInstitution CustodialInstitution SpecifiedInsuranceCompany

Aninvestmententity/organisationlocatedinanon-participatingjurisdictionandmanagedbyanotherFI;Please complete Section 3 for each of your controlling persons who holds more than 20% of ownership.

Anyotherinvestmententity/organisation

Part (2): Non-Financial Institutions (FATCA)

2.2.1 Howdoyoudescribeyourentity/organisation?

AnActiveNon-FinancialForeignEntity(ActiveNFFE)

DirectReportingNFFE

PassiveNon-FinancialForeignEntity(PassiveNFFE)Section 3 needs to be completed for each of your controlling persons who holds more than 20% of ownership.

IfyouareadirectreportingNFFEpleaseprovideyourGIINortheGIINofyoursponsoringentity/organisationandthenameofthesponsoringentity/organisation:

GIIN: . . .

Name:

Please confirm that the sponsoring entity/organisation has agreed with the entity/organisation identified above (that is not a Non-Participating FFI) to act as the sponsoring entity/organisation for this entity/organisation.

CRS

2.2.2 Howdoyoudescribeyourentity/organisation?

AnactiveNFE-acorporationthestockofwhichisregularlytradedonanestablishedsecuritiesmarketoracorporationwhichisarelatedentity/organisationofsuchcorporation

Initials: ...........................................................................................................

PleaserefertoSECTION6fordefinitionofsometermsandacronymsusedinthisform.

1. Entity/Organisation DetailsLegalEntityName:

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Pleasestatethenameoftheestablishedsecuritiesmarketonwhichyourentity/organisationistradedand/orthename.

Name:

AnActiveNFE-aninternationalorganisation AnActiveNFE-agovernmententityoraCentralBank

APassiveNFEPlease complete Section 3 for each of your controlling persons who holds more than 20% of ownership.

3. Entity CertificationPlease continue on a separate sheet if necessary, signing, dating and attaching the sheet to this form.

Controlling Persons Address Tax Residence(s)List all

TIN(s)Provide all

Date of Birth(dd/mm/yyyy)

Controlling Person’s status

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4. Tax Residency Information

4.1. ApplicableforUSspecifiedentity/organisation(FATCA)

WhatisyourUSTIN?

4.2. Applicableforotherjurisdictions(CRS)(Pleaseindicatewhichcountry(ies)andprovideallTIN(s)applicable)

Jurisdiction(s) of residence for tax purposes TIN Identification TypeTIN or other, please specify

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2.

3.

IfyourTINcannotbeprovided,pleasestatewhy:

CUSTOMER DECLARATIONS

1. WeauthoriseMCBLtdtoprovideinformationcontainedinthisformandinformationregardingtheentity/BeneficialOwnerandanyaccountsmaintainedbyMCBLtd,directlyorindirectly,todomesticand/oroverseastaxauthorities,asmayberequiredpursuanttointergovernmentalagreementstoexchangefinancialaccountinformationand/ortheTaxRegulations.

2. Wecertifythatweareauthorisedtosignforandonbehalfoftheentityinrespectofalltheaccount(s)towhichthisformrelates.

3. WeundertaketonotifyMCBLtdwithin30daysofanychangeincircumstanceswhichaffectsthetaxresidencystatusoftheentityand/ortotheaboveinformation(includingchangestotheinformationoncontrollingpersons)andtoprovideMCBLtdwithasuitablyupdatedself-certificationformwithin30daysofsuchchangeincircumstances.Wedeclarethatalltheinformationprovidedinthisformistrue,correctandcompleteandweundertaketoindemnifyMCBLtdanditsOfficersintheeventwewouldhavemadeanymisstatementinthiscertificate.

4. WecertifythatwehavethecapacitytosignfortheentityidentifiedinSECTION1ofthisform.

Please sign below:

Signature: Signature:If more than one signature needed

Name: Name:

Date: / / (dd/mm/yyyy) Date: / / (dd/mm/yyyy)

If you have signed under a power of attorney, please also attach a certified copy of the power of attorney.

An Active NFE other than above e.g. a start-up NFE

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5. CRS/FATCA FACTSHEET

TaxRegulationsapplicabletofinancialinstitutionsrequireMCBLtdtocollectandreportcertaininformationabouteachaccountholder’staxresidencystatus,andincertaincircumstances,informationontheaccountholder’scontrollingperson.

Pleasebeadvisedthatincertaincircumstances,MCBLtdmayberequiredtosharethisinformationthroughtheMauritiusRevenueAuthoritywiththetaxauthoritiesofanothercountryorcountriesinwhichtheaccountholderand/oritscontrollingpersonsmaybetaxresident.

MCBLtd isunable toprovideyouwith taxadvice. Ifyouhaveanyquestionsabouthowtocomplete this form, includingdefiningyour taxresidencystatus,pleasecontactyourtaxadviser.

Youcanalsofindoutmore, includinga listof jurisdictionsthathavesignedagreementstoautomaticallyexchange information,alongwithdetailsabouttheinformationbeingrequestedontheOECD’sAutomaticExchangeofInformation(AEOI)website:www.oecd.org/tax/automatic-exchange/

YoucanfindmoreinformationabouttheimplementationofFATCAinMauritiusathttp://www.mra.mu/download/FATCAGuidance140515.pdf.

6. SUMMARY OF KEY DEFINITIONSThedefinitionsforCRSandFATCAarebroadlysimilar.

Account Holder Personlistedoridentifiedastheholderofafinancialaccount.Apersonholdinganaccountasanagent,custodian,nominee,signatoryorintermediaryforanotherpersonisnottreatedasholdingtheaccount.

Active Non-Financial Entity (Active NFE)/ Active Non-Financial Foreign Entity (Active NFFE)

Broadlyincludes:

• activeNFEs/NFFEsbyreasonofproducingmainlynon-passiveincome(e.g.tradingincome)-lessthan50percentoftheNFFE/NFE’sgrossincomefortheprecedingcalendaryearorotherappropriatereportingperiodispassiveincomeandlessthan50percentoftheassetsheldbytheNFFE/NFEduringtheprecedingcalendaryearorotherappropriatereportingperiodareassetsthatproduceorareheldfortheproductionofpassiveincome;

• publiclytradedNFEs/NFFEs;

• GovernmentalEntities,InternationalOrganisations,CentralBanksandtheirwhollyownedentities;

• holdingNFEs/NFFEsofanon-financialgroup;(v)start-upNFEs/NFFEs;

• NFEs/NFFEswhichareliquidatingoremergingfrombankruptcy;

• treasurycentresofnon-financial-groups;and

• non-profit-makingNFEs/NFFEs.

Certified Deemed Compliant Financial Institution

For FATCA purposes only:CertifiedDeemedcompliantFinancialInstitutionsbroadlyincludethefollowing:

• NonProfitOrganisations;

• FinancialInstitutionswithaLocalClientBase;

• CertainCollectiveInvestmentVehicles;and

• InvestmentAdvisersandInvestmentManagers.

Controlling Persons – Company/Partnership

NaturalpersonwhoexercisescontrolovertheEntity.ForaCompany/Partnership,thiswouldgenerallymeanshareholdershavingatleast20%ownershipinterest.Iftherearenosuchpersons,anyotherpersonhavingcontrolovertheEntity(e.g.amanagingdirector).

Controlling Persons – Trusts/Foundation

Trust:Thesettlor(s),thetrustee(s),theprotector(s),thebeneficiariestotheextenttheyreceivedistributions.

Foundation:Thefounder,thecouncilmembers,thebeneficiariestotheextenttheyreceivedistributions.

CRS TheOECDCommonReportingStandard(commonlyknownas“CRS”)referstothestandardfortheAutomaticExchangeofFinancialAccountInformationinTaxMattersgivenlegislativeeffectinMauritiusbytheIncomeTax(CommonReportingStandard)Regulations2016.

Custodial Institution

MeansanyEntitythatholds,asasubstantialportionofitsbusiness,FinancialAssetsfortheaccountofothers.

SubstantialportionmeanstheEntity’sgrossincomeattributabletotheholdingofFinancialAssetsandrelatedservicesequalstoorexceeds20%oftheEntity’sgrossincomeovertheshorterof(i)thepast3yearsor(ii)sinceithasbeeninexistence.

Depository Institution

MeansanyEntitythatacceptsdepositsintheordinarycourseofabankingorsimilarbusiness.

Direct Reporting NFFE

For FATCA purposes only:ADirectReportingNon-FinancialForeignEntity(DirectReportingNFFE)referstoanentitywhichisnotafinancialinstitutionandelectstoreportinformationaboutitsdirectorindirectsubstantialU.SownerstotheIRS.ItregisterswiththeIRSasaDirectReportingNFFEandmeetsseveralotherdetailedrequirementsdefinedbytheIRS.

Entity Anypersonotherthananaturalperson,e.gcompany,partnership,trust,foundation,société.

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Excepted NFFE For FATCA purposes only:AnExceptedNon-FinancialForeignEntity(ExceptedNFFE)broadlyincludes:

• PublicallyTradedCorporation;

• Non-ProfitOrganisationand

• Non-financialstartups.

Anyotherspecificallyidentifiedclass,includingthoseposingalowriskoftaxevasion,asdeterminedbytheUnitedStates’InternalRevenueService(IRS).

Excluded Accounts

(i) Retirementandpensionaccounts;

(ii) Estateaccounts;

(iii)Certainescrowaccounts;and

(iv)For CRS:Lowvaluedormantaccounts(lessthananamountequivalenttoUSD1000).

For FATCA:Apre-existingindividualaccountwithabalanceoflessthanUSD50,000maybeexempt.

Financial Assets Includesshares,bonds,swapsandothersecurities.Doesnotincluderealpropertyandgold.

Financial Institution

MeansaCustodialInstitution,aDepositoryInstitution,anInvestmentEntityoraSpecifiedInsuranceCompany.

GIIN For FATCA purposes only:GIIN(GlobalIntermediaryIdentificationNumber)isusedbyreportingFinancialInstitutionstouniquelyidentifythemselvestowithholdingagentsandtaxadministrationsforFATCAreporting.FinancialInstitutionscanobtainaGIINfromtheUnitedStates’InternalRevenueService(IRS).

IGA (Inter-Governmental Agreement)

For FATCA purposes only:A governmentmay enter into a bilateral agreementwith the U.S. to simplify reporting compliance and avoid FATCAwithholding.UnderaModel1IGA,ForeignFinancialinstitutions(FFIs)inpartnerjurisdictionsreportinformationonU.S.accountholders to theirnational tax authorities,which in turnwill provide this information to the IRS.Mauritiushaschosenthisoption.UnderaModel2IGA,FFIsreportaccountinformationdirectlytotheIRS.

Investment Entity For CRS purposes: Theterm“InvestmentEntity”includestwotypesofentities:

i. entitiesthatprimarilyconductasabusinessinvestmentactivitiesoroperationsonbehalfofotherpersons,and

ii. entitiesthataremanagedbythoseEntitiesorotherFIs.

AnentitywouldgenerallybeconsideredasanInvestmentEntityifitfunctionsorholdsitselfoutasacollectiveinvestmentvehicle,mutualfund,exchangetradedfund,privateequityfund,hedgefund,venturecapitalfund,leveragedbuy-outfundoranysimilarinvestmentvehicleestablishedwithaninvestmentstrategyofinvesting,reinvesting,ortradinginFinancialAssets.

For FATCA purposes:AsperthedefinitionintheIGAandtheprovisionsoftheU.S.Regulations,anentitymaychoosewhichofthetwoavailabledefinitionsofInvestmentEntitygivenbelowtofollow:

(i) An investment entity within the meaning of the IGAAspersubparagraph1(h)ofArticle1ofthe IGA,anentitywillqualifyasan InvestmentEntitywhere itconductsasabusiness,orismanagedbyanentitythatconductsasabusiness,oneormoreofthefollowingactivities,fororonbehalfofacustomer(e.g.anAccountHolder)–

• trading in moneymarket instruments (cheques, bills, certificates of deposit, derivatives etc.), foreign exchange;exchange,interestrateandindexinstruments;transferablesecurities;orcommodityfuturestrading;

• individualandcollectiveportfoliomanagement;or

• otherwiseinvesting,administering,ormanagingfundsormoneyonbehalfofotherpersons.

(ii) An Investment Entity within the meaning of the US RegulationsAspermittedunder the IGA, thedefinitionof InvestmentEntity included in theUSRegulationsmayalsobeused.AninvestmententityisanyentitythatisdescribedinA,B,orC:

A. Theentityprimarilyconductsasabusinessoneormoreofthefollowingactivitiesoroperationsfororonbehalfofacustomer–

1) Tradinginmoneymarketinstruments(checks,bills,certificatesofdeposit,derivatives,etc.); foreign currency; foreign exchange, interest rate, and index instruments; transferable securities; orcommodityfutures;

2) Individualorcollectiveportfoliomanagement;or

3) Otherwiseinvesting,administering,ormanagingfunds,money,orfinancialassetsonbehalfofotherpersons.

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Investment Entity B. AnentitywillberegardedasanInvestmentEntitywheretheentityismanagedbyaFinancialInstitutionanditsgrossincomeattributabletoinvesting,reinvesting,ortradinginfinancialassets,isequaltoorexceeds50percentoftheentity‘sgrossincomeduringtheshorterof–

• thethree-yearperiodendingon31Decemberoftheyearprecedingtheyearinwhichthedeterminationismade;or

• theperiodduringwhichtheentityhasbeeninexistence.

C. Theentityfunctionsorholdsitselfoutasacollectiveinvestmentvehicle,mutualfund,exchangetradedfund,privateequityfund,hedgefund,venturecapitalfund,leveragedbuyoutfund,oranysimilarinvestmentvehicleestablishedwithaninvestmentstrategyofinvesting,reinvesting,ortradinginfinancialassets.

New Account For CRS purposes: Meansanaccount(whetherheldbyanentityoranindividual)openedonorafter1January2017.

For FATCA purposes: Meansanaccount(whetherheldbyanentityoranindividual)openedonorafter1July2014.

Non-Participating Jurisdiction

For CRS purposes only: AjurisdictionwhichhasnotagreedtoimplementCRS.

Non-Reporting Financial Institution

For CRS purposes: Thesewouldbroadlyincludeentitiesthatfallwithinthefollowingcategories–

• GovernmentEntity;

• InternationalOrganisations;and

• CentralBankofMauritius,etc.PleaseseeAnnex3ofMRA-ImplementationofCRSGuidanceNotesforthefulllist.

For FATCA purposes:Non-Reporting Mauritius Financial Institution means any Mauritius Financial Institution, or other Entity resident inMauritius,i.e.,describedinAnnexIIoftheMRA-ImplementationofFATCAGuidanceNotes,asaNon-ReportingMauritiusFinancialInstitutionorthatotherwisequalifiesasadeemed-compliantFFIoranexemptbeneficialownerunderrelevantU.S.TreasuryRegulations.

Owner Documented Foreign Financial Institution

For FATCA purposes only:AnOwnerDocumentedFinancialInstitutionmustsatisfythefollowingrequirements–

• TheFIissolelyanFIbecauseitisanInvestmentEntity;

• TheFinancialInstitutionmustnotmaintainaFinancialAccountforanyNon-ParticipatingFinancialInstitution;

• TheFinancialInstitutionmustnotbeownedby,norbeamemberofagroupofRelatedEntitieswithanyFinancialInstitutionthatisaDepositoryInstitution,CustodialInstitutionorSpecifiedInsuranceCompany;

• TheFinancialInstitutionprovidesthedesignatedwithholdingagentwiththerequireddocumentationandagreestonotifythewithholdingagentifthereisachangeincircumstances;and

Owner Documented Foreign Financial Institution

• Thedesignatedwithholding agent agrees to report to the IRS (or, in the caseof a reportingModel 1 FFI, to therelevantforeigngovernmentagencythereof)therequiredinformationwithrespecttoanyspecifiedUSpersonsthatareidentified.ThedesignatedwithholdingagentisnothoweverrequiredtoreportinformationwithrespecttoanindirectowneroftheFFI,adeemed-compliant(otherthananowner-documentedFFI),anentitythatisaUSperson,anexemptbeneficialowneroranexceptedNFFE.

Participating Foreign Financial Institution

For FATCA purposes only:FFIthatentersintoanagreementwiththeIRStoundertakecertainduediligence,withholdingandreportingrequirementsforUSaccountholders.

Participating Jurisdiction

For CRS purposes only: AjurisdictionwhichhasagreedtoimplementCRS.ThelatestlistofParticipatingJurisdictionscanbeconsultedat:http://www.oecd.org/ctp/exchange-of-tax-information/MCAA-Signatories.pdf

Passive Income Includesdividends,interests,rents&annuities,royalties,incomefromswaps.

Passive Non-Financial Entity(Passive NFE)/ Passive Non-Financial Foreign Entity(Passive NFFE)

For CRS purposes: PassiveNFE:AnNFEwhichis(i)notanActiveNFE;and(ii)amanagedInvestmentEntitylocatedinaNon-ParticipatingJurisdiction.

For FATCA purposes:ThetermPassiveNFFEmeansanNFFEotherthananActiveNFFEorawithholding foreignpartnershiporwithholdingforeigntrust.

Pre-Existing Entity Account

For CRS purposes: MeansanaccountheldbyanEntityandopenedonorbefore31December2016.

For FATCA purposes:MeansanaccountheldbyanEntityandopenedonorbefore30June2014.

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Registered Deemed Compliant Financial Institution

For FATCA purposes only: Thesewouldbroadlyinclude:

• Non-reportingmembersofagroupofrelatedParticipatingFinancialInstitutions;

• Restrictedfunds;and

• QualifiedcreditcardissuersandSponsoredinvestmententities1.

Related Entity Anentitywhichcontrolsanotherentityortwoentitieswhichareundercommoncontrol(Controlmeansdirectorindirectownershipofmorethan50%ofthevoteandvalueinanEntity).

Reportable Account

AnaccountheldbyoneormoreReportablePersonsorbyaPassiveNFE/NFFEwithoneormoreControllingPersonsthatisaReportablePerson.

Reportable Information

TaxRegulationsrequiretheinformationsuchasname,address,taxresidence,TIN,accountnumber,etc.tobereportedinrespectofAccountHolderswhoareidentifiedbytheBankasholdingReportableAccountswhenapplyingduediligencerulesapplicabletothem.

Specified Insurance Company

MeansanEntitythatisaninsurancecompany(oritsholdingcompany)thatissuesorisobligatedtomakepaymentswithrespecttocashvalueinsurancecontractsorannuitycontracts.Generallyexcludesnon-lifeinsurancecompanies.

Specified US Person

For FATCA purposes only:The termSpecifiedU.S. Person is definedas a SpecifiedU.S. Individual (Private Individual) anda SpecifiedU.S. Entity(Business)2.

SpecifiedU.S.EntityThetermSpecifiedU.S.EntitymeansanyU.S.EntitywhichcannotbeidentifiedasaNon-SpecifiedU.S.EntityorasaU.S.FinancialInstitution.

SpecifiedU.S.IndividualThetermSpecifiedU.S.IndividualmeansanyPrivateIndividualwhoisaU.S.CitizenorU.S.Residentfortaxpurposes.

Tax Regulations “Tax Regulations” refer to regulations implemented in Mauritius to enable automatic exchange of financial accountinformationandincludetheAgreementfortheExchangeofInformationrelatingtoTaxes(UnitedStatesofAmericaFATCAImplementation)Regulations2014and the regulations implemented inconnectionwith theOECDCommonReportingStandard for Automatic Exchangeof Financial Account Information (CRS) as implemented in the relevant jurisdictionspursuanttotreatiessignedbetweenMauritiusandtheUSAforFATCAand/oranyotherjurisdictionsforOECD.

Tax Residence Meanstheresidencefortaxpurposes.Eachcountrywillhaveitsownrulestodeterminetaxresidence.InMauritius,taxresidenceisdefinedinsection73oftheIncomeTaxAct1995.SpecialrulesalsoapplyfortaxresidenceofGBC2companiesandtrusts.

TIN (Taxpayer Identification Number)

Uniquecombinationoflettersornumbersassignedbyajurisdictiontoanindividualorentityandusedtoidentifyingtheindividualorentityfortaxpurposes.E.g.forFrance:Numérod’IdentificationFiscale(NIF).

1 This is defined under US regulations.2 This is mainly a broad definition. For further guidance, please refer to Section (ff) of definitions of the IGA.