Application Form

FATCA

Are you a US citizen or tax resident?* Yes No

A US Citizen has been defined by the IRS as:
An individual born in the United States
An individual born in Puerto Rico, Guam or the US Virgin islands
A former alien who has been naturlised as a US citizen
An individual whose parents is a US citizen

Account Type

What account would you like to open:

What account would you like to open: Banking Investing

Personal Details

Referral Code

Salutation*

First Name*

Last Name*

Email*

Nationality*

Country of Residence*

Your Home Address

Please provide your permanent residential address. We will use your address to confirm your identity.

First line of address*

Second line of address

Town/City/Country*

Postal District*

Employment

Employment status*

Industry*

Occupation*

Employer’s Name*

Financial Details

Annual Income*

Net Personal Assets*

Main source of funds*

Other source of income – Please specify

Customer Knowledge Assessment

Customer Knowledge Assessment, please ensure that you have responded to these questions completely and accurately.

Over the past 3 years, have you transacted at least 6 times in CFDs or leveraged forex? Yes No

Do you have a diploma or higher qualifications in any of the following

Do you have a professional finance-related qualification? Yes No

In the past 10 years, which of the following areas have you worked in for a period of 3 consecutive years?

What is your intended first deposit amount

Account details

Currency USD GBP EUR RMB

List of your other banks (if applicable)

Declaration

Banking

I acknowledge and agree to the Terms and Conditions.

Investing

I acknowledge and agree to the contents of the Risk Disclosure Statement. I confirm and understand the nature and risks of margin trading, particularly that CFDs are not traded on any exchange and that CFDs are geared products meaning that: I can lose more than my initial deposit; I can be called upon to fund my account at short notice; and my positions may be closed if I fail to fund my account sufficiently.*

I understand that my account will be governed by the FAB Investing Customer Agreement. I have read and understood the FAB Investing Customer Agreement and I hereby consent to be bound by its terms in all of my dealings with you. I certify that the information given by me in this form is true and correct.*

I understand that Fidelity Asia Bank Ltd. (Fab). Is an execution only provider and does not offer financial advice, I further acknowledge that Fidelity Asia Bank Ltd. (Fab). Cannot advise me on the suitability of products provided by Fidelity Asia Bank Ltd. (Fab).*

I have received, read and understood Fidelity Asia Bank’s Privacy Policy. I consent to Fidelity Asia Bank Ltd. (Fab) collecting my personal data and personal data about me from sources other than myself, using, disclosing and/or processing my personal data for one or more of the purposes as described in the Privacy Policy. We will not use, disclose and/or process your personal data for purposes that are not explained in the Privacy Policy, without first notifying you and seeking your prior written consent.*

General Consent

I agree that Fidelity Asia Bank Ltd. may contact me by phone, text message or email for service related reasons regarding my products/accounts.*

Fidelity Asia Bank Ltd. may use my details to inform me about new services, products, promotions, or events.* I agree I do not agree

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