Euronext Securities Markets Bourse de Luxembourg CROSS MEMBERSHIP FAST TRACK FORM

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1 Euronext Securities Markets CROSS MEMBERSHIP FAST TRACK FORM

2 1. INTRODUCTION This cross membership fast track application form is for the applicants that are already Members of Euronext or the 1. Please complete only one form. When completed, please return it together with supporting documentation to either the Euronext or the Membership department, depending on which is applicable. MEMBERSHIP DEPARTMENTS Euronext Beursplein JW Amsterdam The Netherlands Tel. +31 (0) euronextmembership@euronext.com B.P. 165 L-2011 Luxembourg Luxembourg Tel Fax membership@bourse.lu All applicants should ensure that, where relevant, they have the appropriate regulatory authorisation(s) to conduct business on the Market(s) in question. Please note that there are restrictions on jurisdictions from where Members may operate. Applicants should be aware that the Competent Authority of the Market(s) to which you are applying may contact your home state regulator for additional information. Host state regulators may also request further information from the applicant directly and may impose fees. For further information please visit the websites or or contact the applicable Membership Department. 1 Applicants who are not already Members of Euronext or should fill in a standard Application form, available from the appropriate membership Department CROSS MEMBERSHIP FAST TRACK FORM EURONEXT BOURSE DE LUXEMBOURG - JANUARY

3 2. DETAILS OF APPLICANT Applicant s statutory name and legal form Commercial name (if different) BIC Code V.A.T. (tax) registration number Registered address Mailing address (if different) Switchboard telephone no. Switchboard fax no. Website address Generic company address Contact name (for use when processing this application) Job title/position Telephone no. (including extension) address CROSS MEMBERSHIP FAST TRACK FORM EURONEXT BOURSE DE LUXEMBOURG - JANUARY

4 3. PROPOSED BUSINESS Please indicate which Euronext Market Membership(s) are being applied for and, for those Markets, indicate the name of the chosen General Clearing Member: Euronext Securities Market 2 Current Membership(s) Membership desired General Clearing Member Amsterdam Securities Brussels Securities Lisbon Securities London Securities Paris Securities Please tick if you would like to become a member of and indicate the name of the chosen General Clearing Member: Current Membership(s) Membership desired General Clearing Member Luxembourg Securities 4. TRADING ACTIVITY Please indicate the type of trading activity you intend to perform on the Euronext Markets: SECURITIES MARKETS Proposed activity(ies) Amsterdam Brussels Lisbon Paris Luxembourg Dealing on own account Execution of orders on behalf of clients 5. STATEMENT In respect of our application for membership of the Euronext Securities Markets or, it is understood that we will be subject to the Rules if our application is successful and certify that the answers and statements in this Form and in the appended documentation are true and complete. WILFUL FALSIFICATION, MISREPRESENTATION, OR OMISSION OF ANY MATERIAL FACT REQUIRED TO BE STATED ON THIS FORM CONSTITUTES CAUSE FOR DENIAL, SUSPENSION, OR REVOCATION OF MEMBERSHIP Signature of applicant Date Job title Signature of applicant Print full name Job title Date Print full name 2 Rule 2602/1 provides automatic membership of all Euronext Securities Markets for MiFID Firms unless the applicant indicates otherwise. CROSS MEMBERSHIP FAST TRACK FORM EURONEXT BOURSE DE LUXEMBOURG - JANUARY

5 APPENDIX A: REGISTRATIONS To be completed by all applicants to the Euronext Securities Markets and We invite you to return also the appropriate forms to identify and register the Authorised Representatives, Responsible Persons, Key Contacts. These documents are available from the appropriate membership department (see details page 2) CROSS MEMBERSHIP FAST TRACK FORM EURONEXT BOURSE DE LUXEMBOURG - JANUARY