Name: QCP Capital
Address: 3 Phillip Street, Royal Group Building, #13-04, Singapore, Singapore, 048693, Singapore
Telephone: +65 8127 2246

Individual / Institution*
- Individual
- Institution

Name of Company*
Entity Type*
Nature of Business*
Full Name (as in passport):*
Email:*
Phone Number*
Preferred Communication Platform*
Does the phone number you provided correspond with your profile on the preferred platform?*
If "No", please provide your number/username on preferred platform*

Country of Operations*
Country of Incorporation*
Date of Registration*
Company Registration Number*
Date of Birth*
Nationality*
ID / Passport Number*

Email (for correspondence)*
Name of Contact Person*
Contact Number*
Communication Platform Preferred*
Does the contact number you provided correspond with your profile on the preferred platform?*
If "No", please provide your number/username on preferred platform*
Country of Birth*
Occupation*

Company Registered Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is the correspondence address the same if the registered address?*
Correspondence Address (if different from above)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
if employed*
if self-employed*
Residential Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Annual Turnover*
Annual Profit*
Source of Income*
Expected Trading size*

Which bank is your company bank account maintained with?*
Expected Trading size*
Were you referred by anyone?
Authorized Person/Entity to give instruction to QCP for trades*
Name of Authorized Signatories Residential Address ID/Passport No. Date of Birth Contact Number Nationality

Any person(s) that you have authorized to trade on your behalf?
Individual shareholders (with ≥ 20% holding)*
Full Name Residential Address ID/Passport No. Date of Birth Director (Yes/No) Shareholding (% of holding)
Corporate shareholders (with ≥ 20% holding)*
Name of Entity Registered Address Company Reg. No. Date of Incorporation Country of Incorporation Shareholding (% of holding)
Directors (who are not among the above shareholders)*
Full Name ID/Passport No. Nationality Residential Address Date of Birth
Bank Account Maintained with*
Referred by*
If other(s), who referred you?*
Bank Account Authorized Person
Will there be any authorized person(s) or any controlling person(s) identified for this account? (If yes, please provide the details of the authorized persons in the following boxes)
- Yes
- No
Authorized Person Details*
Name ID / Passport Number Nationality Relationship Date of Birth

Declaration

We hereby declare that the above information provided by us is true, complete and correct and that we have not wilfully withheld any material fact. We further declare that we have never been made bankrupt and there is no litigation or petition filed against us in the past or presently. In addition, we declare that we have never committed any offence under any laws.

We hereby authorize and give QCP Capital Pte Ltd (“QCP”) our irrevocable consent to make such enquiries and conduct all the necessary checks on us and obtain from and/or verify with any source and/or disclose or release any information relating to us to any party or source as QCP, may from time to time, deem fit without any liabilities or notice to us.

We hereby authorize QCP to disclose any information of us and/or data relating to ourselves to the Vendor (seller), Supplier and/or Dealer by phone, electronic mail, short messaging service (SMS) or any means of communication which QCP deems appropriate.

We hereby further acknowledge that QCP reserves the right to reject our application without assigning any reason and retain documents submitted by us.
Declaration*
- I have read and agree to the terms in the Declaration.

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Declaration

Name of Authorized Signatories	Residential Address	ID/Passport No.	Date of Birth	Contact Number	Nationality

Full Name	Residential Address	ID/Passport No.	Date of Birth	Director (Yes/No)	Shareholding (% of holding)

Name of Entity	Registered Address	Company Reg. No.	Date of Incorporation	Country of Incorporation	Shareholding (% of holding)

Full Name	ID/Passport No.	Nationality	Residential Address	Date of Birth