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First Name

Last Name

Email

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Address

City

State

Zip

Account Type Arbitrage Fund Lay fund

Account Currency GBP EUR USD

Annual Income --select one-- Upto 25000 25001-50000 50001-100000 100001 Above Upto 5000 Above 5000 Upto 5000 Above 5000

Employment Status Self Employed Full Time Employed Retired Unemployed Other

Approximate Value of Savings and Investments --select one-- Upto 25000 25001-50000 50001-100000 100001 Above Upto 5000 Above 5000 Upto 5000 Above 5000

Source Of Fund Other Inheritance/Gift Previous Investments Employment Own Business

Shares Bonds & Investments Never Rarely (1 to 5 trades per year) Occasionally (6-10 trades per year) Often (11-15 trades per year) Very often (16 or more trades per year)

CFD / Spread Betting Experience Never Rarely (1 to 5 trades per year) Occasionally (6-10 trades per year) Often (11-15 trades per year) Very often (16 or more trades per year)

Warrants or other Financial Derivatives Never Rarely (1 to 5 trades per year) Occasionally (6-10 trades per year) Often (11-15 trades per year) Very often (16 or more trades per year)

Professional Experience Yes No

Understand Risk Yes No

Professional Qualification / Education / Relevant training Yes No

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