LDF and Swiss-UK Tax Agreement 
Annex D: Certification of tax compliance 
CERTIFICATION OF TAX COMPLIANCE 
[insert name and adress of Financial Intermediary] 
Reference: [insert reference] 
Self-certification of tax compliance made by or on behalf of 
..........]] C the Relevant Person") 
with regard to: 
…[] C the Relevant Property") held, adminis- 
tered or managed by: 
........[] ("the Financial Intermediary” which 
expression shall include their lawful successors or assignees) 
Dear Sirs 
1. You have identified the Person named above as a "relevant person" in accordance with the 
provisions of the Memorandum of Understanding signed by the Government of the Principality of 
Liechtenstein and the United Kingdom tax authority, Her Majesty’s Revenue & Customs ("HMRC"), 
on 11 August 2009 ("the MoU") and subsequent implementing legislation passed in Liechtenstein®* 
("the Implementing Legislation"). I acknowledge that, by reason of your status as a "financial inter- 
mediary" (as defined in the MoU), you are under a duty to obtain evidence that a relevant person with 
"relevant property" in Liechtenstein (as defined in the MoU) is: (i) not liable to tax in the United 
Kingdom ("UK") or (ii) compliant with their UK tax obligations in relation to such relevant property. 
2. For the purposes of the provisions of the MoU and the Implementing Legislation, I hereby 
DECLARE that the Relevant Person is: 
(a) U not liable to tax in the UK in relation to the Relevant Property for each of the four tax years 
prior to the date of this certification and, where appropriate, for the period to the present date; * 
  
53 Law of 30 June 2010 on Administrative Assistance in Tax Matters with the United Kingdom of Great Britain 
and Northern Ireland ("UK TIEA Act"), Liechtenstein Law Gazette 2010 No. 248. 
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