Application Form MT4 Forex Trading Account

Transcription

1 Application Form MT4 Forex Trading Account To: Avestra Capital Level 2, 2 Miami Key Broadbeach Waters Queensland, Australia, 4218 The Product Disclosure Statement (PDS) issued by Avestra Capital Pty Ltd contains important information relevant to a decision to open a MT4 Forex trading account with Avestra Capital Pty Ltd. You MUST read, consider and accept the PDS and Terms and Conditions before completing this Application Form. Completion and submission of this Application Form denotes your acceptance of the terms and conditions of the PDS. To comply with our obligations under Anti-Money Laundering and Counter-Terrorism Financing legislation, we must collect certain information about each Applicant and you are required to send the following documentation as set out in sections A or B as applicable, along with the Application Form. To facilitate client approval process as well as part of ongoing client profile updates, Avestra Capital Pty Ltd also reserves the right to request for further documentation at any time during the approval process or client relationship. A: Individual Clients 1) Proof of Identity Valid Passport or Government Identity Card (Identification and signature page required) 2) Proof of Residency Government Identity card Driver's License Bank Statement Utility Bill All documents must be of at least 6 months validity B: Corporate Clients Certificate of Incorporation or Transcript from local Commerce Agency Signed Memorandum and Articles of Association Proof of Authorised Signatures who can sign on behalf of the corporate entity Documentation of Ownership Structure Proof of Identity of and Proof of Address for all authorised signatures Proof of Identity of and Proof of Address for all beneficial owners Depending on the jurisdiction of incorporation, official Proof of Identity and Proof of Address for all directors may be required Please complete all information as accurately as possible in block CAPITAL letters with a black or blue pen 1

2 ALL Clients must complete Part 1, Part 2 and Part 6 of the Application Form Individual Clients must complete Part 3 Corporate Clients must complete Part 4 and Part 5 PART 1 GENERAL - to be completed by ALL clients INDIVIDUAL CLIENTS Full Name (as per ID/passport) Date of Birth (dd/mm/yyyy) Nationality City and Country of Birth Occupation Company Name (or Educational Institution if you are a student) Address of Company / Educational Institution Nature of Employer's Business Years of current Employment Corporate Name Residential / Registered Address City and Postal Code State/Province Mailing Address (if different from above) City and Postal Code State/Province Address Primary phone number Secondary phone number CORPORATE CLIENTS ALL CLIENTS Country Country Country Code + Country Code + Experience in Investing Beginner Experienced Very Experienced PART 2 CHOICE OF ACCOUNT CURRENCY - to be completed by ALL clients Choice of Account Currency PART 3 INDIVIDUAL DISCLOSURE - only to be completed by Individual clients Financial information and other particulars of applicant Gross Annual Income Below US$ 50K US$ 50K to US$ 100K US$ 100K to US$ 150K US$ 150K to US$ 200K US$ 200K to US$ 300K Above US$ 300K Networth Below US$ 100K US$ 100K to US$ 200K US$ 200K to US$ 500K US$ 500K to US$ 1M US$ 1M to US$ 2M Above US$ 2M 2

3 PART 4 CORPORATE DISCLOSURE - only to be completed by Corporate clients Company Primary Business Country where Business Operation is located Date of Incorporation Place of Incorporation Average Gross Profit for the Past 3 years US$ Indicative Account Size US$ Estimated Net Assets Below US$ 3M Above US$ 1OM US$ 3M to US$ 10M Name and address of each Director (Proof of Identity to be Provided) Please indicate in tick box which Director will be an (only 1 required) Name (Director 1): Name (Director 2): Name (Director 3): Name (Director 4): PART 5 CORPORATE OWNERSHIP - only to be completed by Corporate clients In order to comply with regulations in Anti Money Laundering legislation, Avestra Capital must verify the identity of private individuals connected to the corporate entity applying for an account. This covers all private individuals owning 25% or more of the shares in the corporate entity. Individuals who ultimately own or control the company by direct or indirect ownership or control of 25% or more of the shares or voting rights in the company, except if the shares are listed on a regulated marketplace. Individuals exercising control over the management of the company, in ways other than those listed above. Individuals who, according to the articles of association or otherwise specified, are entitled to receive 25% or more of the distributed funds or other assets of a fund or similar legal arrangement, assuming these persons are known. Individuals in whose main interest the fund or similar legal arrangement has been established or acts. Individuals who exercise control over a minimum of 25% of the distributed funds or other assets of the fund or similar 3

4 PART 5 CORPORATE OWNERSHIP - only to be completed by Corporate clients Please provide the particulars of the shareholders owning 25% or more of the shares in the corporate entity: Name Shareholding Please provide documentation confirming the ownership structure of your company. This could be in the form of a share certificate/register or a form/declaration of corporate structure. Those individuals, who qualify as beneficial owners in accordance with the criteria listed above, must comply with the due diligence requirements stated in Section A - "Individual Clients." Any significant changes in the ownership structure must be immediately reported to Avestra Capital Please note that all information supplied is kept confidential. PART 6 SIGNATURE AND CONSENT - to be completed by ALL clients I/We declare by my/our signature(s) To have read, understood and agreed to the Product Disclosure Statement To have read, understood and agreed to the Terms and Conditions To have received and understood the nature and content of the Financial Services Guide To have received, read and understood the product information material relating to the relevant products; and To have received satisfactory answers to all my/our questions regarding the terms, conditions and other issues relating to the relevant products Furthermore I/We confirm: That the information provided by me/us and inserted in this form is correct and complete; That I/we undertake to give Avestra Capital notice in writing of any change in particualrs given above and to submit relevant documentary proof to Avestra Capital for any change of the particulars given above; That the investment amount has been chosen by me/us taking my/our total financial circumstance into consideration and is by me/us considered reasonable and suitable for my/our investment objectives under such circumstances; That Avestra Capital is entitled to send newsletters or other general circulation investment product related materials to me/us by , sms or similar electronic messaging services, and that I/we must inform Avestra Capital in writing, if I/we do not wish to receive such materials; That for non-corporate accounts, I/we act in my/our own name as specified above and not on behalf of a third party in respect of all matters related to this client relationship. Accordingly, all funds to be deposited and traded on the account with Avestra Capital are my/our own funds; That I/we confirm that where we are a corporate, I/we declare that I/we act on behalf of the named legal entity/corporation and not on behalf of a third party in respect of all matters related to this client relationship. Accordingly, all funds to be deposited and traded on the account with Avestra Capital are its own funds; That I/we specifically acknowledge and agree that Avestra Capital will provide me/us execution only services and non financial advisory services. As such, Avestra Capital is not my/our advisor in any manner for any transaction I/we may effect. Signature of Individual Applicant / Authorised Signatory of Corporate Applicant Name Designation Date 4

5 Disclaimer This information provided herein is only for general information and accessibility. None of the information contained herein constitute an offer (or solicitation of an offer) to buy or sell any currency, product or financial instrument, to make any investment, or to participate in any particular trading strategy. Avestra Capital does not take into account your personal investment objectives, specific investments goals, specific needs or financial situation and makes no representation and assumes no liability to the accuracy or completeness of the information provided herein. Trading Forex and Derivatives carries a high level of risk to your capital and you should only trade with money you can afford to lose. Trading Derivatives may not be suitable for all investors, so please ensure that you fully understand the risks involved, and seek independent advice if necessary. For Office Use: 5