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Personal Account Request Form (FOREX) Please fill out all the entries. Without all the information we cannot open the account.

Personal data Last name: Name: Title (Mr/Mrs): Identity Card or Passport Number: Date of Birth: Home address: City and Province: Country: Postal Code: Telephone (during office hours): Mobile phone: Fax: Email:

Banking and Financial Information Approximate annual income (before taxes) in USD$: Approximate value of your savings and investments (without including your house) in USD$: Origin of those funds (Work, Inheritance, Investments, Savings): Approximate value of your house:

Statements I understand the nature of risk that entails operating with Forex. I affirm that the following information has been provided to me through the website, risk warning and Contract with the Client. Therefore, I confirm that I have read, understood and accepted to be bind by the terms contained in these documents. Finally, I affirm that I hold legal age and the information I have provided is true and correct.

_________________________________________ Signed (please include your full name and surname)

Regus China Life Tower ∙ 5/F,China Life Tower, No.16 Chaowai Street∙ Beijing ∙ 100020 ∙ P.R.China Phone: +86 10 5877 1111 Fax: +86 10 5877 1222

Cisus electronic signature forex personal account request form en  
Cisus electronic signature forex personal account request form en