ANNEX B 
Confirmation (Trust Structures') with respect to tax compliance of assets 
Name of the Account: 
Account Holder ("AH"): 
  
  
Country (ies) of Tax Residence AH": 
  
Tax Identification Number(s) AH*: 
Name of the Trust Related Party ("TRP"): 
  
Capacity of the TRP with regard to the above referenced account: 
Settlor 
Discretionary beneficiary 
Income Beneficiary/fixed interest trust 
Capital Beneficiary/fixed interest trust 
Revoker (revocable trust) 
Enforcer (purpose trust) 
O0O00O0O000 
Other, please indicate: 
  
Date and Country of Birth TRP: 
  
Country (ies) of Tax Residence TRP^: 
Tax Identification Number(s) TRP*: 
  
  
This confirmation ("Confirmation") relates to, and is limited to, the banking relationship with Bank AG ('Bank") 
referenced above. 
The undersigned, being related to the account/custody account ("Account") and trust referenced herein in the capacity 
as stated above ("Trust Related Party" ar "TRP"), hereby confirms that he/she has complied with and will continue to 
comply with his/her tax obligations, if any, in his/her country(ies) of tax residence as stated above with respect to the 
assets deposited on the Account and/or income and capital gains generated by such assets. 
The Trust Related Party undertakes to notify the Bank - via the account holder of the Account ("Account Holder") - 
immediately in case of a change of his/her tax status (whether by reason of a change in his/her residence, citizenship, 
domicile or otherwise). Furthermore, he/she will provide the Bank - via the Account Holder - with the confirmations of 
compliance with tax and reporting obligations reasonably requested by the Bank. 
Unless the assets deposited on the Account are regularized under the Tax Agreement Austria or the Tax Agreement 
UK* by way of one-off payment for the past and final withholding tax going forward, the following applies: 
        
  
1 Ifthere are several Trust Related Parties under this business relationship, each of them will have to fill out a copy of this form. 
2 Please list all countries in which the indicated person/entity is taxable based on residence, domicile or citizenship. 
3 Please list all tax identification numbers, if any. 
4 Tax Agreement Austria means the agreement between Switzerland and the Republic of Austria on cooperation in the area of taxes and 
financial market, dated 13 April 2012. Tax Agreement UK means the agreement between Switzerland and the United Kingdom 
of Great Britain and Northern Ireland on cooperation in the area of taxation, dated 6 Qctober 2011. 
Zurich 1/2 
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