SIPP Account Application Form

SIPP Account Application Form Effective Date: 24 February 2016 APPLICATION INSTRUCTIONS The following supporting documentation must accompany the SIPP s completed Account Application Form: - For the SIPP trustees to provide on the initial set up of the SIPP Scheme at LMAX Exchange. If the SIPP Trustee is aware that the up-to-date trust deed and any supplemental deed of the Scheme has been provided previously, then there is no need to provide these again. SIPP Scheme Trust Deed and any supplementary Trust Deeds. Evidence of registration of the Scheme with Pensions Regulator or HMRC. - For the SIPP Member (beneficiary), which may also be a Co (Second) -Trustee A copy of your valid and signed passport, driving license etc. Proof of residency, such as a copy of your bank statement or utility bill (e.g. gas, water, electricity, land line phone, internet and cable TV connections) issued in your name in the previous 3 months. - Limited Power of Attorney ( LPOA ), which is attached. We are unable to open SIPP accounts without this documentation. Please check the details that you have provided are correct and that the application form is signed. Then please send your completed application to us by post, fax or email with scanned copies using the following details: Post Email LMAX Yellow Building 1A Nicholas Road London W11 4AN United Kingdom registrations@lmax.com Fax +44 20 3192 2572

SIPP Account Application Form Complete the following form to open a SIPP account. Please complete all sections in full and using BLOCK CAPITALS (any section left incomplete will delay the processing of your application). Please call +44 20 3192 2555 should you have any questions. Details of SIPP Scheme Scheme Name: Address of SIPP Scheme, if different, to SIPP Trustee Address Line 1: Address Line 2: Country: HMRC ref: Designated SIPP A/C name for this application: Town: County: Post code: Business tel. no: SIPP Plan ref: SIPP Trustee Details SIPP Trustee name: Registered company number of the SIPP Trustee: FCA Firm Reference no (FRN) of the SIPP Trustee: Legal Entity Identifier Code (LEI): Is SIPP Member (beneficiary) acting as a co (second) trustee: YES / NO Primary Contact at the SIPP Trustee Title: Mr Mrs Ms Miss Dr Other Please specify: First name: Surname: Mobile tel. no: Email address: Registered Company Address of the SIPP Trustee Address Line 1: Address Line 2: Address Line 3: Country: Town: County: Post code: Business tel. no: Correspondence Address of the SIPP Trustee Address Line 1: Address Line 2: Address Line 3: Country: Same as registered address (tick) Town: County: Post code: Business tel. no:

SIPP Bank Details Bank Name: Bank Address: Postcode: Country Account Name: Account No: Sort code: Or IBAN BIC Approx. SIPP funds available for the purposes of trading with LMAX: Account and Security Details Proposed Username: (Memorable word between 6-20 characters in length) Mother s Maiden Name: Account Base Currency: GBP EUR USD AUD CAD JPY CHF SEK SGD HKD Father s first name: SIPP Member (Beneficiary) Details Title: Mr Mrs Ms Miss Dr Other Please specify: First name: Surname: Date of Birth: Address Line 1: Address Line 2: Address Line 3: Nationality: Town: County: Post code: Country of Residence: Email address Primary phone number: (mobile preferred) Secondary phone number: (landline) Trading Experience (Excludes trades for which you received financial advice) The trading experience of SIPP Member (beneficiary) Have you traded FX in the past 12 months? No Yes averaging: 1-4 trades per month 5-10 trades per month 11-20 trades per month 20+ trades per month Have you traded CFDs or Futures in the past 12 months? No Yes averaging: 1-4 trades per month 5-10 trades per month 11-20 trades per month 20+ trades per month Do you have a relevant education or professional qualification that you consider would you assist your understanding of CFDs/Forex or leveraged products? Yes No

If trading is to be carried out by the SIPP Trustee, then the below should indicate the experience of the officer who is an authorised manager or supervisor of trading activities Have you traded FX in the past 12 months? Yes averaging: 1-4 trades per month 5-10 trades per month 11-20 trades per month 20+ trades per month Have you traded CFDs or Futures in the past 12 months? Yes averaging: 1-4 trades per month 5-10 trades per month 11-20 trades per month 20+ trades per month Do you have a relevant education or professional qualification that you consider would you assist your understanding of CFDs/Forex or leveraged products? Yes No No No If trading is to be carried out by the SIPP Trustee, details of persons authorised to do so: Signature: Date D D M M Y Y Y Y Full name: Position: Signature: Full name: Position: Date D D M M Y Y Y Y SIPP Trustee Declaration In signing and returning this form we confirm for the SIPP Scheme that: We have full power and authority to enter into the LMAX Agreement which is described in bullet point 3 below with LMAX on behalf of the SIPP Scheme and all trustees and authorised signatories of the SIPP Scheme are over 18 years of age; We declare that the information we have provided as part of this application process is true, accurate and complete and, should there be any subsequent changes to this information, We will inform LMAX immediately in writing; We have read and understood and agree to be bound by the LMAX Agreement that is comprised of the current versions published on the website of (a) the Terms of Business, (b) Product Information Schedules, (c) the Risk Warning Notice, (d) the Trading Manual, (e) Instrument Information, (f) the Order Execution Policy, (g) (where applicable) the API agreement, and (h) the SIPP Margin and Miscellaneous Schedule. We acknowledge that all of the documents that constitute the LMAX Agreement and supplementary documents as available from the website including, but not limited to, our Privacy Policy and Summary Conflicts of Interest Policy, or any other document that may form part of your agreement with us, may be amended from time to time as permitted by the terms of the Terms of Business and that any later versions will govern my trading relationship with LMAX from the effective dates set out in the Terms of Business; We consent to the Order Execution Policy and for any orders to be executed outside a regulated market or a multilateral trading facility; We consent to any unexecuted limit order not to be made public; The SIPP Scheme is properly constituted and validly exist under the laws of its jurisdiction and has the authority to conduct its business; The SIPP Member (beneficiary) may trade in the investment types / instruments (Permitted Investments) listed in the SIPP Margin and Miscellaneous Schedule and that by doing so the SIPP Member (beneficiary) will not be in breach of any laws or regulations nor the provisions in the SIPP Trust Deed; We understand that, in order to comply with anti-money laundering legislation, LMAX, in relation to the SIPP Trustee or their representatives and SIPP Member, may use information held in any database or in other electronic format; The SIPP Trustee have obtained the consent of each of the authorised signatories and SIPP Member to the electronic identity verification searches or to provide the required documentation; We are aware that the trading service provided by LMAX carries a high level of risk and can result in losses that exceed the balance of cash held on the account at any time; and You are not permitted to reduce the Margin requirement described in your SIPP Margin and Miscellaneous Schedule without our prior approval. This restriction on reducing the Margin requirement is imposed to assist us in meeting HMRC s requirement that the SIPP Scheme must not at any time borrow any more than 50% of the net value of the SIPP Trust.

Agreement By signing this form we represent that all the information contained herein is true, complete and accurate and we agree on behalf of the SIPP Scheme to be bound by the Agreement. Signature: Full name: Position: Date D D M M Y Y Y Y Signature: Date D D M M Y Y Y Y Full name: Position:

SIPP Margin and Miscellaneous Schedule Margin requirements: FX: 10% CFDs on Spot Gold and Silver: 20% CFDs on Commodities: 10% CFDs on Indices: 10% Permitted Investments: Spot FX Rolling Spot FX Spot Gold and Silver Rolling Spot Gold and Silver CFDs on Commodities CFDs on Indices Miscellaneous Terms: The liability of the SIPP Trustee will not be personal and shall be limited to the assets of the particular member within the SIPP Scheme relating to this account at LMAX.

Limited Power of Attorney for a SIPP Account The Account Holder with LMAX Trader The Attorney Name of SIPP Trust Name Name of Trustee (1) Name of Co-Trustee (2) (if there is a second trustee i.e: member / beneficiary) Full address of Attorney Full address of SIPP Trust Email of Attorney Email of SIPP Trust Phone number(s) AUTHORITY BY THIS POWER OF ATTORNEY made by way of deed, the Account Holder hereby appoints the Attorney (with no power of substitution) and in the Account Holder's name or otherwise and on his behalf, as from the date of signature of this Power of Attorney: a) to give instructions to trade and to give investment orders on behalf of the Account Holder in connection with all funds and other assets in the Account Holder s account(s) listed above under LMAX Account Number(s) (the Accounts ); and b) to give such instructions and orders freely and repeatedly and without limitation, thereby increasing or diminishing the funds or other assets in the Accounts. LIMITATION The Attorney is not authorized to withdraw or pledge funds or other assets from any of the Accounts or transfer funds or other assets between the Accounts. The Attorney is not authorized to make payments into the Accounts other than from the Account Holder s own credit card or bank accounts. The Attorney shall only be authorized to the extent that the Account Holder provides him with the login details and passwords of the Accounts. REVOCATION This Power of Attorney shall remain in full force and effect until such time as LMAX Limited receives and confirms receipt of:

a) a written notice of revocation from the Account Holder; or b) valid documentary evidence of the death, presumed death, bankruptcy or loss of legal or mental capacity of either the Account Holder or the Attorney. Any revocation or termination of the Power of Attorney pursuant to a) or b) above shall not affect the validity, ratification or indemnity in respect of any instructions/orders given or transactions begun prior to LMAX Limited receiving such notice or evidence. RATIFICATION The Account Holder hereby ratifies and confirms whatever the Attorney does or purports to do in the exercise of any power conferred by this Power of Attorney. This Power of Attorney in no way affects any and all rights* conferred to LMAX Limited under any agreements between the Account Holder and LMAX Limited. INDEMNITY The Account Holder will fully indemnify and hold harmless LMAX Limited, and its successors and assigns, against all claims, losses, costs, expenses, damages or liability which the Account Holder or LMAX Limited sustain or incur as a result of any act or omission of the Attorney (including any cost incurred in enforcing this indemnity). GOVERNING LAW AND JURISDICTION This Power of Attorney (and any dispute, controversy, proceedings or claim of whatever nature arising out of or in any way relating to this Power of Attorney or its formation or any act performed or claimed to be performed under it) shall be governed by and construed in accordance with English law and the Courts of England shall have exclusive jurisdiction to hear and decide any suit, action or proceedings and/or settle any disputes which may arise in connection with this Power of Attorney or its formation or any act performed or claimed to be performed under it. SIGNATURES IN WITNESS whereof this Power of Attorney has been executed and delivered as a deed on the following date. Date:

Executed as a deed by the Account Holder Trustee name:.. Insert name of company acting by: Insert name of first director Insert name of second director / secretary. Signature of first director. Signature of second director / secretary Trustee name: Witness name. Insert name of individual.. Signature of Individual In the presence of Witness name:. Insert name of individual.. Signature of Individual Full Address of witness Occupation of witness Attorney I hereby acknowledge receipt of the power described above and accept my appointment as agent and attorney-in-fact for the Account Holder. Signature *IMPORTANT NOTE* It is your responsibility to monitor your Account at all times including when you have authorized an Attorney to exercise specific limited activities on your behalf under this Power of Attorney. For the avoidance of doubt you will be responsible for any losses on your Account even when you have allowed another person to use your Account.