Individual agreement open live account

Declaration of U.S. Citizenship or U.S. Residence for Tax purposes

Please tick either (a) or (b) and complete as appropriate

* Declaration:

(a) I confirm that I am not a US citizen and don't reside in the United States and Don't have a US Tax ID.

(b) I confirm that I am a US Citizen and reside in the United States or have a US Tax ID.

Declaration of Tax Residency (Other than U.S)

I hereby confirm that I am, for tax purposes, resident in the following countries (indicate the tax reference number type and number applicable in each country)

*Country

*Tax Reference number type:

*Tax Reference number:

Country

Tax Reference number type:

Tax Reference number:

Country

Tax Reference number type:

Tax Reference number:

Employment Information

* Employment Status:

Employed

Self-Employed

Retired

Unemployed

* Annual Salary:

Less than $25,000 Sign

$25,000 to $50,000

$50,000 to $100,000

Over $ 100,000

(Please give full particulars including country of origin. Phrases such as ‘transferred from another company’ or ‘investments’ are not sufficient. If the wealth is derived from the sale of a business, the description should indicate the name of the business & activities of the company. If the funds were generated through accumulated earnings, the affidavit should include information as to your employer, your position, & number of years employed. Specific details of the source of funds introduced are essential to enable us to confirm the funds are legal in origin. We reserve the right to request further documentation to support this declaration.)

*Source of Funds:

Total Assets

* Total Annual Income:

Less than $25,000 Sign

$25,000 to $50,000

$50,000 to $100,000

Over $ 100,000

* Approximate Net Worth:

Less than $25,000 Sign

$25,000 to $50,000

$50,000 to $100,000

Over $ 100,000

* Anticipated Investment:

Less than $25,000 Sign

$25,000 to $50,000

$50,000 to $100,000

Over $ 100,000

Declaration of Source of Wealth

* Source of Wealth:

Income from profession/employment

Inheritance or Divorce Settlement

Company Ownership / Sale of Company or Assets

Company Ownership and Profits

Investments or Savings

Rental income / Sale of Real Property

Gift

Lotteries

Other income

*Declaration:

I/We declare (as an authorized signatory for the Applicant) that the information provided in this Form, is to the best of my knowledge and belief, accurate and complete. I/we further confirm that my/or wealth is from legitimate sources as indicated above, and that I/we will also provide the required evidence of the source of wealth as is required.*

* Are you connected to bankruptcies?:

Yes

Trading & Investment Experience
Please check the following which best describe your investing experience:(if you have no prior investing experience please sign "Supplemental Risk Disclaimer")

On-Exchange Securities

Years of experience:

Trading volume:

Frequency of trading:

Leverage FX, CFD's and Precious Metals

Years of experience:

Trading volume:

Frequency of trading:

Commodities

Years of experience:

Trading volume:

Frequency of trading:

Futures

Years of experience:

Trading volume:

Frequency of trading:

Options

Years of experience:

Trading volume:

Frequency of trading:

Mutual Funds

Years of experience:

Trading volume:

Frequency of trading:

Extra Information

*Volume of the anticipated deposits on an annual basis:

*Purpose for account:

* Management of account:

Self - management

Third party manager

You act as professional manager (i.e. manages the accounts of others)

Please, download here the Limited Power of Attorney and attach it on the field below.

*Limited Power of Attorney: Choose a file…… |

Introducing Broker, if applicable:

Sales person, if applicable:

Promo code, if applicable:

*Do you want to have referrals?:

Yes

*How many offices do you have?

Please list Cities where your offices are located

*Are you actively soliciting new customers?

Yes

*What number of complaints have you received in the past two years?:

Yes

*If any, what types of complaints were received (what was each customer alleging)?:

*Have you received any customer complaints that allege excessive trading in discretionary accounts?:

*Any complaints that allege unauthorized trading?:

Yes

*Generally describe below and attach hereto (on step 4 of this application) documentation regarding any and all disciplinary actions taken by any regulatory agencies (put "n/a" if doesn't apply):