Italian Financial Transaction Tax – Exemption Application Form

Italian Financial Transaction Tax – Exemption Application Form
Article 19, par. 3, of the Treasury Decree 21 February 2013
Section I
ENTITY DETAILS
Legal Entity Name or account number(s) (1)
Registered Address (2)
Postal Code (2)
City (2)
Country (2)
Management Company Legal Name (applicable to pension funds) (3)
Section II
DECLARATIONS AND UNDERTAKINGS
The undersigned …………………………………….…….(name of the entity indicated in fields nr.1. or 3), duly represented by its authorized
Signatory (please attach your latest authorized signatory list)
DECLARES FOR THE PURPOSES OF ARTICLE 19, PAR. 3, OF THE TREASURY DECREE 21 FEBRUARY 2013
1. That all transactions on Italian equities and similar instruments in respect of the above Legal Entity or account number(s) shall be exempted
from the Italian Financial Transaction Tax under Article 1, par. 494, of Law 24 December 2012 n. 228 and Article 16, par. 1, lett. a) of the
Treasury Decree 21 February 2013, for the reason that it qualifies as one of the following entities or institutions (select relevant option):
(a) the European Union, the European Institutions, the European Atomic Energy Community; □
(b) bodies covered by the Protocol on the Privileges and Immunities of the European Union or the European Central Bank and the European
Investment Bank; □
(c) the central banks of the Member States of the European Union and the central banks and organizations managing also the official reserves of
other States; □
(d) bodies or international organizations established in accordance with international agreements enforced in Italy, as listed in a specific regulation
of the Italian tax authorities (lacking such regulation, reference shall be made to the entities listed in Attachment 1 to this Form). □
or
2. That any purchases of Italian equities or similar instruments by the above Legal Entity or account number(s) shall be exempted from the Italian
Financial Transaction tax under Article 1, par. 494, of Law 24 December 2012 n. 228 and Article 16, par. 5, of the Treasury Decree 21 February
2013, for the reason that it qualifies as one of the following entities or institutions (select relevant option):
(a) pension funds subject to supervision under Directive 2003/41/EU, established (i) in the Member States of the European Union or (ii) in the
States which are parties to the Agreement on the European Economic Area and allow an adequate exchange of information with Italy (as of 1
March 2013: Norway and Iceland only); □
(b) compulsory social security institutions, established (i) in the Member States of the European Union or (ii) in the States which are parties to the
Agreement on the European Economic Area and allow an adequate exchange of information with Italy (as of 1 March 2013: Norway and Iceland
only); □
(c) persons and entities participated solely by the pension funds in (a) above (so-called pension funds pooling vehicles); □
(d) other supplementary pension schemes referred to in Legislative Decree No 252 of 5 December 2005. □
3. That the information contained herein is true and valid.
AND UNDERTAKES
1. To immediately notify if at any time any of the above declarations ceases to be true and correct (4).
2. To indemnify […………] on a continuous basis against any costs, expenses, liabilities and losses, including any penalties and interest, that
[……..….] suffers or incurs as a direct result of the declarations and/or undertaking being incorrect.
AND ACKNOWLEDGES
That [addressee] relies and will be relying on the above declarations and undertakings for not charging the Italian Financial Transaction Tax set
forth by Art. 1, par from 491 to 500, of the Law 24 December 2012 n. 228 and by the Treasury Decree 21 February 2013, as from time to time
amended and or supplemented, to all future transactions on Italian equities and similar instruments
Signature for and on behalf of [name of entity in field nr. 1 or 2.]
Date..........................................................
....................................................................................
(1) For pension funds, enter here the legal name or account number(s) of the pension fund and, in field nr. 3, the legal name of the management company.
(2) Indicate the required details of the Entity in field nr. 1
(3) If the Entity in field nr. 1 is a pension fund or the account(s) in filed nr. 1 relate to a pension fund, enter here the legal name of the management company.
(4) Such notifications shall be sent to……..