Form descriptions - Relief at source and quick refund - Polish debt securities

Information is provided here about the forms and their use in relation to the procedure for relief at source and quick refund of withholding tax on income from Polish bonds.

One-Time Certificate for Polish debt securities, T-bonds, or EUR-Mortgage bonds

This certificate provides information regarding the client of Clearstream, stating that the client holds Polish debt securities on behalf of one or more beneficial owners that are entitled to apply for relief.

The original one-time certificate form must be duly completed and signed by the Clearstream client and, must be provided once before the first income/redemption payment.

The One-Time Certificate, duly completed and signed, is valid for 5 years. Changes to any of its details must be communicated to Clearstream without delay in a new certificate.

Per-Payment instruction

In order to instruct for a relief or exemption at source, the client must provide a per-payment instruction via Swift formatted MT565 or Xact Web Portal, which includes the following details:

• Client Account Number;
• ISIN;
• Corporate Action Reference ID;
• Payment Date;
• The total holding of securities;
• Full name, Fiscal address, and TIN number of the Beneficial Owner;
• Country of Residence for Tax Purposes;
• Tax rate to apply;
• Holding for which the reduced/exempt tax rate applies;
• Purchase price;

Xact Web Portal users: in the beneficial owner details sequence under “benfplace”.

Certificate of tax residence (original or as electronic copy)

A Certificate of Tax Residence (CoTR) (original or copy) must be provided by beneficial owners requesting a reduced tax rate/ full tax exemption. The CoTR must fulfil the below requirements:

• Be issued by the beneficial owner’s local tax authority;
• Include the beneficial owner’s full name, full address and country of tax residence;
• Include the Tax Identification Number (TIN);

The CoTR must cover the payment date and remain valid until the end of the respective calendar year.

Beneficial Owner declaration (statement A)

The Beneficial Owner (BO) declaration is a self-certification that identifies the beneficial owner and their status.

This document must be completed and signed by the beneficial owner (BO) or its representative under a POA, then notarised and apostilled b.

Beneficial Owner declaration for Supranational organisations (statement B)

This is a self-certification identifying the beneficial owner and their status as a supranational organisation. This document must be completed and signed by the beneficial owner (BO) or its representative under a PoA, then notarised and apostilled by the beneficial owner (BO) or its representative under a PoA.

Extract from recipient’s commercial registrar

The extract from the commercial registrar is an official document issued by the official body responsible for registering companies in a specific jurisdiction.  

Company establishment documents 

Company establishment documents refer to the articles of incorporation/formation of a company. These documents legally establish the company and define its structure, purpose, and operating rules.

These documents are specific to each entity and must comply with specific legal requirements.

RAS statement from beneficial owner (Statement C, F or D)

Specific statement which supports the respective status of the beneficial owner: for banks (Tax Forms to use – Statement C), exempted investment funds (Tax forms to use – Statement F) and exempted pension fund (Tax forms to use - Statement D). 

Latest financial statements together with the auditor’s opinion (if such opinion is available)

A financial statement is a formal, written record of a company's financial activities and position.  

An auditor's opinion is the formal conclusion expressed in the audit report by an independent, external auditor after conducting an audit of a company's financial statements.

Important Note: Financial statements without the auditor’s opinion will be accepted only if such an opinion  has not been issued.

Power of Attorney - Omnibus account

A Power of Attorney should be provided if a third party is completing the Declaration of Beneficial Ownership. A notarial confirmation is required, confirming that the person signing the PoA is authorised to act on behalf of the beneficial owner.

The document must be provided once before the first applicable income payment and remains valid until revoked.