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Waiver of data protection and banking secrecy

for natural US persons

Customer Name

Customer Number

Address, post code, place

Nationality

Date of birth

E-mail

Telephone

Fax

Account management:

Mobile telephone

On own account

I am aware that Capital Bank -GRAWE Gruppe AG has entered into a contractual agreement with the Inernal Revenue Service of the United States of
America (hereinafter referred to as IRS) in order to participate as a foreign financial institution in the implementation of the US Foreign Account
Compliance Act (FATCA). Therefore, Capital Bank -GRAWE Gruppe AG is obliged to evaluate its customers with respect to their US tax status and
to report personal data of identified US persons to the IRS on a regular basis.
In the light of the above, I declare that I expressly agree that Capital Bank -GRAWE Gruppe AG may collect, process and store any personal data of
me as may it be required under its contractual obligations to the IRS. Further, I expressly agree the Capital Bank -GRAWE Gruppe AG may forward
such data to the IRS.
This authorisation is also an expressly waiver in respect of banking secrecy in accordance with 38 Para 2 point 5 of the Banking Law, as amended,
as well as a consent to the use of my data in conformity with 8 Para 1 point 2 and 9 point 6 of the Data Protection Act 2000, as amended, and to
forward such data to third parties outside the European Union, namely to the IRS.
This waiver is construed under and governed by the laws of the Republic of Austria. Exclusive place of jurisdiction is the competent court in Graz.
This waiver may be revoked at any time in writing.

______________________________________
Place, Date

dieplattformderCapitalBankGRAWEGruppeAGFN112471z,LGGrazDVR:0043974BLZ19600Firmensitz:8010Graz
MitglieddesVerbandessterreichischerBankenundBankiers

______________________________________________
Signature of Customer

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