Client Update Form

Personal Details
Title
First Name*
Last Name*
ID Card/Residence Document No.*
Marital Status*
Date of Birth*

DayMonthYear
Date
Country of Birth*
Occupation*
Country of Work/Retirement*
How many nationalities do you have?

1 Nationality2 Nationalities3 Nationalities
1st Nationality*
2nd Nationality*
3rd Nationality*
Are you a politically exposed person?*

YesNo
PEP Relationship*
PEP Type*

Contact Details
Residential Address*
Is your correspondence address the same as residential address?*

YesNo
Correspondence Address*
Personal Mobile Country Code*
Personal Mobile Number*
Landline Country Code
Landline Number
Email Address*
example@example.com
Please confirm your preferred communication method*

ElectronicPaper
We encourage you to consider switching to electronic communication as this will help us contribute towards a more sustainable environment

Tax Residence Status
We are obliged under Maltese Legislation 123.127 entitled “cooperation with other jurisdiction on tax matters” to collect certain information about your tax arrangements. If your citizenship or your tax residence is not Maltese, we may be legally obliged to pass on your details and other financial information with respect to your policies held with us to the Commissioner for Revenue. The CFR may exchange this information with tax authorities of another country/jurisdiction(s) pursuant to intergovernmental agreements to exchange financial information, in terms of the FATCA and the OECD Common Reporting Standard (‘CRS’).

If your tax residence is Malta and you are a Maltese national, your 'Tax Identification Number' is your identity card number. If you are not a Maltese national but a Maltese tax resident you would have been issued with a unique taxpayer reference number, made up of 9 digits, generated by the Commissioner for Revenue.

Declaration of Citizenship by Investment / Residence by Investment Scheme (CBI/RBI Scheme)
Did you obtain residence rights under a Citizenship by Investment / Residence by Investment Scheme?*

YesNo
Please specify Jurisdiction for which residence rights were obtained via Citizenship by investment / Residence by investment scheme *
Do you hold residence rights in any other jurisdiction(s)?*

YesNo
Jurisdictions*
Have you spent more than 90 days in any other jurisdictions during the previous year?*

YesNo
Additional Jurisdictions*
In which jurisdiction(s) have you filed personal income tax returns during the previous year?*

Declaration
1. Hereby acknowledge that the information given in this form shall form part of my policy and I acknowledge that all information herein provided is subject to the same conditions as shown on the application form and policy document(s).
2. Acknowledge that the information contained in this form and information regarding me and any reportable policy may be provided to the Commissioner for Revenue and exchanged with tax authorities of other countries/jurisdiction(s) in which I may be tax resident pursuant to intergovernmental agreements to exchange financial account Information.
3. Bind myself to inform MAPFRE MSV Life p.l.c throughout the term of the policy, should there be any change to any of the information provided in this form.
Signature
To complete your request, we kindly ask that you upload a clear and legible copy of your ID Card or Residence Document from the front and back.
ID Card Copy/Residence Document (front)*

Cancelof
ID Card Copy/Residence Document (back)*

Cancelof
Date of Submission*

DayMonthYear
Date
Should be Empty:

Personal Details