Claim for refund of dividend tax

About the claimant

I claim refund of Faroese dividend tax as

Select 'shareholder' if you owned the shares at the time of distribution

Select 'agent' if you are making the claim on behalf of a shareholder.

Shareholder Agent (by power of attorney)

Select 'Next' and enter your information.

When you make a claim on behalf of a shareholder we need certain information about you in your capacity as an agent. Please complete the following.

You are

This applies to, for example, private individuals or sole proprietorships (natural persons).

Company applies to, for example, companies, associations, funds, states, public institutions, pension funds (legal persons/entities).

a person a company etc.

Select the relevant identification and complete the field Tax identification number (TIN) I don't have a TIN Tax identification number (TIN)

The tax identification number (TIN) is the number you use to identify youself/your company to your local authority.

See TIN definitions for various OECD countries.

Date of birth (dd-mm-yyyy) Place of birth State/county of birth

Name and Address

Where do you live (country)? First name(s) Surname c/o name Address (street, no., letter, floor, left/right) Premises Postal code and postal district Town PO box

Contact information

Email Phone number (preferably mobile) Enter phone number incl. country code

Select the relevant identification and complete the field Tax identification number (TIN) Other identification Tax identification number (TIN)

Identification number

Name and Address of agent

Where is the company domiciled (country)? Company name c/o name Address (street, no., letter, floor, left/right) Premises Postal code and postal district Town PO box

Contact information

Point of contact (POC) Email Phone number (preferably mobile) Enter phone number incl. country code

About the shareholder

The shareholder is

This applies to, for example, private individuals or sole proprietorships (natural persons).

Company applies to, for example, companies, associations, funds, states, public institutions, pension funds (legal persons/entities).

a person a company etc.

Select the relevant identification and complete the field Tax identification number (TIN) The shareholder does not have a TIN Tax identification number (TIN)

The tax identification number (TIN) is the number you use to identify youself/your company to your local authority.

See TIN definitions for various OECD countries.

Date of birth (dd-mm-yyyy) Place of birth

Enter the name of the town where you were born. Such information is usually in your birth certificate or passport.

State/county of birth

Enter the name of the country or state where you were born. Such information is usually in your birth certificate or passport.

Name and Address

Where does the shareholder live (country)? First name(s) Surname c/o name Address (street, no., letter, floor, left/right) Premises Postal code and postal district Town PO box

Contact information

Email Phone number (preferably mobile) Enter phone number incl. country code

Select how you want to identify the company and complete the field Tax identification number (TIN) The shareholder does not have a TIN Tax identification number (TIN)

The tax identification number (TIN) is the number you use to identify youself/your company to your local authority.

See TIN definitions for various OECD countries.

Identification number

Name and Address

Where is the company domiciled (country)? Company name c/o name Address (street, no., letter, floor, left/right) Premises Postal code and postal district Town PO box

Contact information

Point of contact (POC)

Enter the name of a person in the company for TAKS to contact if necessary.

Email Phone number (preferably mobile) Enter phone number incl. country code

Refund information

Is the application in accordance with a double taxation agreement? Yes No

ISIN-code ISIN-code to identify the share

An ISIN code (International Securities Identification Number) is a global code used to identify securities – for example shares, bonds, futures, and other financial instruments.

Name of distributing company Select date for when the dividend distribution was approved

Often, it is the date for the annual general meeting.

Number of shares applied for Enter the number of shares in whole units Dividend received before tax (in whole DKK) Faroese tax rate withheld

As a general rule 35% of the total dividend has been withheld as dividend tax. See your dividend voucher for the Faroese tax rate withheld. However, there are a number of exceptions allowing the receipient of dividend to receive a dividend to which a lower tax rate applies.

Tax rate payable to Faroe Islands, e.g. according to double taxation agreement.

The final tax rate according to your country´s double taxation agreement of your tax rate, according to present Faroese law will be automatically inserted into the field. The tax rate of most double taxation agreements is 15% of the total dividend.

Amount of refund (DKK)

Gross dividend * (Faroese tax rate withheld - Tax rate payable to Faroese)/100 = amount to be refunded. If the amount to be refunded is incorrect, please check the figures entered in the fields above.

Documentation for dividend received and tax withheld (for example dividend voucher, bank statement, custody account statement, purchase voucher)

Here you can attach documentation stating that you have received dividend, that Faroese dividend tax has been withheld and that you were the beneficial owner of the shares at the time when the dividend distribution was approved, etc. Such documentation could be, for example, purchase vouchers, dividend vouchers, bank statement and custody account statement. Other documentation may also be relevant.

Payment information

Would you like your refund transferred to a Faroese or Danish account? Yes No

Select to which account you would like the refund transferred (Faroese or Danish).

Name of bank Enter name of bank Registration no. Enter registration number

Enter the registration number of your Faroese or Danish bank account.

Account no. Enter account number

Enter the registration number of your Faroese or Danish bank account.

Reference

Enter your possible reference no. here. This reference no. will be stated in the payment information.

Please note that your bank must be able to accept money transfers in DKK.

Name of bank Enter name of bank Name of account holder Enter name of account holder Address of account holder Enter address of account holder BIC/SWIFT Enter BIC/SWIFT

Bank identifier code/Society for worldwide interbank financial telecommunication. International number to identify the bank. The information is used to identify the account into which the refund is to be made. You can find the number in your online banking.

IBAN no. Enter IBAN

IBAN is your international banking account number. The information is used to identify the account into which the dividend is to be made. You can find the number in your online banking.

Routing no./FEDWIRE/ABA Enter routing no./FEDWIRE/ABA

The routing no. has nine digits. It is also called FEDWIRE or ABA.

Please state account number, if relevant, in the field ‘IBAN’.

Reference

Enter your possible reference no. here. This reference no. will be stated in the payment information.

Claim for refund of dividend tax

About the claimant

Name and Address

Contact information

Name and Address of agent

Contact information

About the shareholder

Name and Address

Contact information

Name and Address

Contact information

Refund information

Other documentation

Payment information

Summary

How we process your personal data

Bank	Reg.	Account	BIC/SWIFT	IBAN
Betri Banki	9181	152.861.2	EIKBFOTF	FO65 9181 0001 5286 12
BankNordik	6460	101.104.0	FIFBFOTX	FO29 6460 0001 0110 40
Norðoya Sparikassi	9865	100.188.9	NOYAFO21	FO09 9865 0001 0018 89
Suðuroyar Sparikassi	9870	100.084.6	SUSPFOT1	FO21 9870 0001 0008 46
Danske Bank	3100	169.349.92	DABADKKK	DK88 3000 0016 9349 92