1. Trading Platform MetaTrader 4 2. Account Leverage 100:1 200:1 400:1 Other* * Subject to written confirmation by Alpha Capital Markets. 3. Trading Account Type Micro Account Standard Account Premier Account DMA 4. Name and Address Surname: Forenames: [Minimum deposit US$500; Forex only] [Minimum deposit US$1,000; Forex, CFD's and precious metals] [Minimum deposit US$10,000; Forex, CFD's and precious metals] [Minimum deposit US$30,000; Forex and precious metals] Title: Date of Birth (DD/MM/YY): Permanent Residential Address: City/Town: Country: Postcode: Time spent at your current address: < 3 years >3 years Previous address (if less than 3 years): City/Town: Country: Postcode: 5. Contact Details Phone (country code/area code/number): Mobile (country code/area code/number) Fax (country code/area code/number): Email: Page 1 of 5
6. Employment Employed If employed please give details (all fields are mandatory): Employers Name: Nature of Business: Position Held: Self Employed If self-employed please give details (all fields are mandatory): Business Name: Retired Student Unemployed Nature of Business: If you are registered with the FCA or similar regulatory body, please tick box 7. Financial Background Approximate Annual Income (USD): Approximate Savings / Investments (USD): (excluding property) Approximate funds available for trading (USD): Source of funds (Please select): Employment Investment Inheritance Real Estate Other (Please specify): 8. Client Categorisation Please select: Retail Client Professional Client Eligible Counterparty Refer to Clause 2.2 of the Client Agreement for the definition of these categories, or contact us for further information Page 2 of 5
9. Investment Experience Do you understand the risks of trading margined products? Yes No Refer to our Risk Disclosure Notice. If you do not understand the risks please contact us before continuing. Do you have an Alpha Capital Markets Demo Account? Yes No Please indicate your investment experience (all fields are mandatory): Instrument Experience (in months) FOREX (Spot or Forward) Contract For Difference (CFD) Equities/Bonds Equity Indices, Futures or Options Financial / Commodity Futures or Options Spread Betting Please indicate the anticipated frequency of your transactions: Instrument Frequency of deals (per month) FOREX (Spot or Forward) Contract For Difference (CFD) Equities/Bonds Equity Indices, Futures or Options Financial/Commodity Futures or Options Spread Betting 10. Live Account Details Account Currency (Please select) USD GBP EUR CHF JPY Security question and answers: Please select your preferred security question by providing your appropriate answer to one of the following: Your father s middle name: Your mother s maiden name: Your pet s name: Your favourite sports team: Your first car: Your favourite TV show: Your favourite food: Your favourite colour: Page 3 of 5
11. IB number/agent Account If you have been referred by an introducing broker or agent, please specify their name, address and account number (if known): 12. Risk Warning Forex forwards and CFD's are leveraged products. They may not be suitable for you as they carry a high degree of risk to your capital and you can lose more than your initial investment. You should ensure you understand all of the risks. You should also be satisfied that these products are suitable for you according to your circumstances, market knowledge and financial position. 13. Notice and Declaration I Confirm that I am over 18 and declare that the information provided by me during the account opening process is true and correct and undertake to notify you, in writing, if there are any changes to this data. I guarantee that I do not breach any regulations of my country of residence in trading with Alpha Capital Markets. I am a regular user of the internet and consent to Alpha Capital Markets providing information to me about changes to the Client Agreement by posting such information on the company website: www.alpha-capitalmarkets.com 14. Agreements Yes, I have read and agree to Alpha Capital Markets Client Agreement, a copy of which may be found at http://www.alpha-capitalmarkets.com. Yes, I have read and agree to Alpha Capital Markets Risk Disclosure Notice, a copy of which may be found at www.alpha-capitalmarkets.com. This Agreement sets out the terms and conditions on which we will provide you with services from time to time. This Agreement together with the Client Agreement and other related agreements and notices that we may provide you with from time to time together constitute the terms of your agreement with us. This is our standard Client Application Form upon which we intend to rely. For your own benefit and protection you should read these terms carefully before signing this Agreement. If you do not understand any point contained within this Agreement, please ask for further information before signing this Agreement. We are authorised and regulated by the Financial Conduct Authority (the FCA ) under Firm Reference Number 441689 for the conduct of investment business under the Markets in Financial Instruments Directive ( MiFID ) and Financial Services and Markets Act 2000 ( the Act ). Please indicate in the Client Application Form whether you are a Retail Client, Professional Client or Eligible Counterparty for the purposes of the FCA Rules, as defined in clause 2.2. Page 4 of 5
Please ensure that you have read the attached terms and conditions carefully and then sign and return this to us at the following address: Alpha Capital Markets, 6 Old Hall Barns, Thurston Road, Pakenham, Bury St Edmunds, IP31 2NG We have read and accept the terms of the Agreement set out above: Signed I/We have read and accept the terms of the Agreement set out above: Signed Name Position Dated (for and on behalf of Alpha Capital Markets) (DD/MM/YYYY) Name Position Dated ( Client ) (DD/MM/YYYY) Page 5 of 5