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Taro Pharmaceutical Industries Ltd.
c/o Taro Pharmaceuticals U.S.A., Inc.
Three Skyline Drive
Hawthorne, New York 10532
(NYSE: TARO)
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CONTACTS:
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Mariano A. Balaguer
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William J. Coote
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VP, CFO
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AVP, Business Finance, Treasurer and Investor Relations
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(914) 345-9001
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(914) 345-9001
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Mariano.Balaguer@taro.com
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William.Coote@taro.com
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1. |
The Company has appointed IBI Trust Management, located at Ehad Ha’am 9 Tel Aviv (Shalom Tower); e-mail address IBI-CM@IBI.co.il; phone number +972 506 209 410 as its trustee/
sub-paying agent (the "Tax Trustee"), in compliance with the ITA Conditions.
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2. |
On the dividend payment date, December 28, 2018, the Company shall withhold 15.09% (the "Withheld Tax Rate") of the gross amount of the Dividend. The Company shall transfer such amount to the Tax Trustee by January 1, 2019. The remaining amount of the Dividend (84.91%) shall be paid to
shareholders by the American Stock Transfer & Trust Company, LLC (the Company’s stock transfer agent) or the relevant broker for shares held in street name.
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3. |
Any shareholder of the Company who is: (i) a resident of a country with which Israel has a treaty for the avoidance of double taxation and (ii) has an
equitable right to receive the Dividend (an "Applicant"), may apply to the Tax Trustee, from the Dividend payment date until February
14, 2019, and request that the withholding tax rate that shall apply to his share of the Dividend payment be reduced in accordance with a relevant tax treaty (the "Application").
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4. |
In order to submit an Application, the Applicant shall submit to the Tax Trustee the documents listed in Attachment A.
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5. |
The Tax Trustee shall review all of the Applicant's documents, as well as any other document which may be required in order to establish the Applicant's
eligibility for a reduced tax rate. If an Applicant’s documents are insufficient, the Tax Trustee may revert to the Applicant with questions or requests for additional documents.
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6.
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Upon an Applicant’s satisfactory submission of the required documents, the Tax Trustee shall transfer to the Applicant’s designated bank account a tax refund in
the amount by which the Withheld Tax Rate exceeds the tax rate actually due from the Applicant under the applicable tax regime.
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7. |
The above-mentioned application process is only a "fast track" that has been made available to shareholders to avoid an excessive tax withholding that exceeds
the tax that should have been withheld from their Dividend payments based on their entitlement to the benefits of a tax treaty. It neither affects, in any way, the substantive tax liability of any shareholder nor does it derogate from a
shareholder’s right to file a tax return with the Israeli tax authority to seek a refund of over withheld amounts.
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Full name of the recipient:
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For Individuals:
Identity Number, Social Security No., or Passport No.
_______________________
For Legal Entities:
Registration No. /Corporation No.
_______________________ |
Type of Investor:
Legal Entity ☐
Individual ☐
Trust Beneficiary ☐
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With respect to an individual
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With respect to a legal entity
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Date of birth:
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The country in which it was incorporated:
The country in which control and management are conducted:
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Country of residence:
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Country of citizenship:
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Country issuing passport:
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Income Tax File or tax identification number of the recipient in place of residence: __________________
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Address of local income tax assessing office in recipient’s place of residence:
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The recipient is a fiscal resident of (insert country) _____________________________ since (insert date)________________ .
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Permanent Address (country, city, street, house or apartment number):
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Mailing Address:
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Investor's Telephone number:
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Telephone number of authorized signatory:
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☐
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1.
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The State of Israel is not my permanent place of residence.
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2.
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The State of Israel is neither my place of residence nor my family's place of residence.
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3.
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My ordinary or permanent place of activity is not within the State of Israel, and I do not have a permanent establishment in the State of
Israel.
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4.
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I do not engage in any occupation within the State of Israel.
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5.
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I do not own a business or part of a business within the State of Israel.
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6.
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This year, I did not stay, and I do not intend to stay in Israel for 183 days or more.
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☐
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7.
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This year, I did not stay in Israel and I also do not intend to stay in Israel for 30 days or more and my total stay in Israel this year
and in the two preceding years will not reach 425 days.
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8.
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I am not insured with the National Insurance Institute in the State of Israel.
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9.
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I am the sole beneficial owner of the dividend income.
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10.
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I do not hold the shares directly or indirectly for the benefit of another person.
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11.
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The income is not attributable to a place of business or permanent establishment located in a country other than my country of residence.
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☐
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1.
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Over 75% of the shareholders are individuals with the same residency as the Legal Entity (attach a declaration of shareholders)
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2.
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It is not registered /incorporated with the Registrar of Companies in Israel.
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3.
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It is not registered with the Registrar of non-profit organizations in Israel. (Amutot)
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4.
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The control of the legal entity is not in Israel.
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5.
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The management of the legal entity is not in Israel.
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6.
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The legal entity does not have a permanent enterprise in Israel and the entity does not have
a permanent establishment in the State of Israel
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☐
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7.
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No Israeli resident holds, directly or indirectly via shares or through a trust or in any other manner, alone or with another who is an
Israeli resident, one or more of the means of control of the legal entity, as specified below, at a rate exceeding 25%. The term "means of control" refers to the following:
(a)the right to participate in profits;
(b)the right to appoint a director;
(c)the right to vote;
(d)the right to share in the assets of the entity
at the time of its liquidation;
(e)the right to direct the manner of exercising
one of the rights specified above.
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☐
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8.
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The legal entity is the sole beneficial owner of the dividend income.
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☐
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9.
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The entity does not hold the shares directly or indirectly
for the benefit of another person.
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☐
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10.
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The income is not attributable to a place of business or
permanent establishment located in a country other than country of residence.
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Country
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City
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Bank name and account number
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Amount
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Date of Signature
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Signature of Recipient
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Date of Signature
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Signature
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Official Stamp
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1.
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Copy of passport or identity card issued by the country of tax residency of shareholder.
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2.
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Bank or brokerage statement from the dividend record date including details of the account holder, bank or brokerage name and account
number and the number of listed shares held by the shareholder.
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3.
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Bank or brokerage statement from the date of payment of the dividend, including details of the account holder,
account number and the amount of the dividend received.
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4.
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Residency certificate issued by the Applicant’s country of residence for the purposes of the tax treaty between Israel and the
Applicant’s country of residence.
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1.
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Copy of Certificate of Incorporation issued by the country of tax residency of shareholder.
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2.
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For private companies, (i) a list of shareholders of the Legal Entity; and (ii) list of the direct and indirect individual
shareholders, their ownership percentages and declarations regarding their country of residency for tax purposes. Such list must include at least 75% total ownership of the Legal Entity.
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3.
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For public companies or direct or indirect subsidiaries of public companies, a statement declaring the Legal Entity’s country of
residence.
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4.
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Bank or brokerage statement as of the dividend record date including details of the account holder, bank or brokerage name and
account number and the number of listed shares held by the shareholder.
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5.
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Bank or brokerage statement as of the date of payment of the dividend, including details of the account holder, bank or brokerage
account number and the amount of the dividend received.
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6.
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Residency certificate issued by the Applicant’s country of residence for the purposes of the tax treaty between Israel and the
Applicant’s country of residence.
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