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First name Last name Country of Residence State/Province Phone number - E-Mail Address Confirm E-Mail Address If you do not want to receive additional information, please check the following box Trading Platform Which FXDD platform do you intend to use for trading? Would you like to use a Virtual Private Server? Yes No Is This Account A Joint Account? Yes No

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Have you ever traded leveraged products? How was the account managed? How long have you been trading CFDs for? How many CFD contracts/standard lots have you traded in the last 12 months? Do you have any professional qualification or have attended any courses or seminars that have given you an understanding of our products? If yes, please provide the details