1. Personalia ROYAL WEST INDIES BROKERS N.V. NEW IB-ACCOUNT FORM Account Holder Surname: Given Name(s): Maiden/Former Name(s) Date of Birth: (dd) (mm) (yyyy) Residential Address: Sex: Male Female Marital Status Single Married Divorced Widowed Telephone Number: E-mail Address: Highest Level of Education: Master Bachelor Secondary 2. Professional Information Profession: Employer details: Number of people relying on your income: page 1 van 5
3. Tax information Country(ies) of Tax Residency (or a non-resident taxpayer) Tax Reference Number 1. 2. 3. 4. U.S. Citizen, Legal Alien or Resident for Tax Purposes in the U.S. I confirm that I AM a United States of America Citizen, legal alien or resident for tax purposes in the United States of America and that I am up to date and compliant with the International Revenue Service (IRS) and with applicable obligations under the Foreign Account Tax Compliance Act (FATCA). My United States Social Security Number or Taxpayer Identification Number is: SSN/TIN: 5. Bank Account Bank: Address: Account Holder: Account Number: (IBAN/BIC/SWIFT) Initial Deposit: (the minimum initial deposit is US$ 7,500. ) page 2 van 5
6. Corporate Account In addition to the information requested above, please also provide the following details if you are opening a corporate account. Company Name: Chamber of Commerce Nr: Address: Contact Details: 7. Security Questions What is your grandmothers first name? Where was your first job? What is the name of your high school? 8. Base Currency If you answered Other, Royal West Indies Brokers will contact you. Base Currency: US Dollar (USD ) Euro (EUR) British Pound (GBP) Other 9. Account Type Royal West Indies Brokers offers a standard margin account on behalf of the client. Please contact your Royal West Indies Brokers Advisor to discuss other account types. If you answered Other, Royal West Indies Brokers will contact you. Margin Account Other 10. Investment Objective Income Growth Trading Profits Hedging Speculation Preservation of capital page 3 van 5
11. Trading Experience Years of Experience Amount of Transactions per year Stocks: Options: Futures: Bonds: Currency: 12. Level of Knowledge Stocks: Limited Good Excellent Options: Limited Good Excellent Futures: Limited Good Excellent Bonds: Limited Good Excellent Currency: Limited Good Excellent 13. Regulatory Information - Are you, or any immediate family member who resides in the same Yes household, registered as a broker-dealer or an employee, director or owner of a securities or commodities brokerage firm? - Have you ever been the subject of, or initiated litigation, arbitration Yes or any other type of dispute or settlement procedure with another broker or dealer? If yes, why? - Are you a director, a 10% shareholder or do you exercise effective Yes control of any publicly traded company? - Do you exercise control over the trading or the profits of Yes any other Interactive Brokers account? page 4 van 5
14. Financial Background (in US$) Net Worth < 15.000 15.000 35.000 35.000 75.000 > 75.000 (w/o residence) Net Worth < 150.000 150.000 250.000 250.000 400.000 > 400.000 (incl. residence) Liquid Net Worth < 15.000 15.000 35.000 35.000 75.000 > 75.000 Estimated Annual < 30.000 30.000 40.000 40.000 75.000 > 75.000 Income 15. Trading Options Royal West Indies Brokers will request all trading permissions that fit the profile of the client according to Interactive Brokers. All trading options as approved by Interactive Brokers. 16. Application for Market Data Receiving market data comes with a monthly cost, but is not mandatory. When checked Yes, Royal West Indies Brokers N.V. will contact you with additional information. Would you like to receive market data? Yes 17. Signature By signing this agreement, the Client confirms that: - the Client has received the document Basic Client Agreement (IB Accounts), has read its content and has understood and accepted it. The Client explicitly agrees that any amendments made to this document will henceforth be sent to the Client by electronic means; - the Client has read, understood and agreed to the contractual conditions of Interactive Brokers (IB) regarding the service it offers to the Client (The IB Customer Agreement ); - the Client thoroughly examined and answered the information and questions on this form to the best of the Client s knowledge and beliefs, especially questions regarding the investment objective, trading experience and financial background. (date), (city), (signature) (name) page 5 van 5