SECTION 14. — Internal Revenue Bulletin 1999-5

Sec. 14.01. QI’s application to become a qualified intermediary and all the Appendices and Attachments to this Agreement are hereby incorporated into and made an integral part of this Agreement. This Agreement, QI’s application, and the Appendices and Attachments to this Agreement constitute the complete agreement between the parties.

Sec. 14.02. This Agreement may not be amended, modified, or superceded other than by written agreement of QI and the IRS.

Sec. 14.03. Any waiver of a provision of this Agreement is a waiver solely of that provision. The waiver does not obligate the IRS to waive other provisions of this Agreement or the same provision at a later date.

Sec. 14.04. This Agreement shall be governed by the laws of the United States. Any legal action brought under this Agreement shall be brought only in a United States court with jurisdiction to hear and resolve matters under the internal revenue laws of the United States.

Sec. 14.05. QI’s rights and responsibilities under this Agreement can not be assigned to another person.

Sec. 14.06. Notices provided under this Agreement shall be directed as follows:

February 1, 1999 48 1999–5 I.R.B.

To the IRS

Office of the Assistant Commissioner (International)

Foreign Payments Branch OP:IN:D:WT 950 L’Enfant Plaza South, SW Washington D.C. 20024

To QI:

Notices shall be mailed registered, first class air mail.

Sec. 14.08. QI, acting in its capacity as a qualified intermediary or any other capacity, does not act as an agent of the IRS, nor does it have the authority to hold itself out as an agent of the IRS.

IN WITNESS WHEREOF, the above parties have subscribed their names to these presents, in triplicate.

Signed this day of , 1998

__________________________________ (name and title of person signing for QI)

Internal Revenue Service

By________________________________

Assistant Commissioner (International)

1999–5 I.R.B. 49 February 1, 1999

Appendix A

[Name of QI]

[Name of country] (see Attachment 1, for description of know-your customer rules).

[Name of country] (see Attachment 2, for description of know-your customer rules).

. . . .

[Name of entity affiliated with QI]

[Name of country] (see Attachment ____, for description of know-your customer rules).

February 1, 1999 50 1999–5 I.R.B.

ATTACHMENT ⁴

QI is subject to the following laws and regulations of [name of country] governing the requirements of QI to obtain documentation confirming the identity of QI’s account holders.
QI represents that [name and citations to laws and regulations identified in item 1, above] are enforced by [name of enforcement body] and QI shall provide the IRS with an English translation of any reports or other documentation issued by [name of enforcement body] that relates to QI’s compliance with [laws and regulations identified in 1, above].
QI represents that the following penalties apply for failure to obtain, maintain, and evaluate documentation obtained under [name and citations to laws and regulations identified in item 1].
QI shall use the following documentary evidence to comply with section 5.03 of this Agreement:

a. For natural persons:

b. For legal persons:

QI shall follow the procedures set forth below to establish a person’s permanent residency address.
QI shall follow the procedures set forth below to confirm the identity of account holders that do not open accounts in person.
QI represents that it will follow the procedures set forth below to determine whether an account holder is acting as an intermediary, and, if it is, to identify the beneficial owners for whom the intermediary is acting.
QI shall follow the procedures set forth below to obtain new documentation, or renew existing documentation, in accordance with

[name and citations to laws and regulations identified in item 1].

QI shall retain the documentary evidence obtained under [name and citations to laws and regulations identified in item 1] for the following period.