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*

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

Which bank is your company bank account maintained with?*
Expected Trading size*
Were you referred by anyone?*
Who were you referred by?*
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*
Are you referred by anyone?*
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

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

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