Execution Only Client

Account Type *

Account Application

Retail Client Agreement

I confirm that I have read, understood and agree to the Retail Client Agreement.

Advisory Fees and Charges

I confirm that I have read and understood the Fees and Charges.

ISA Declaration

I confirm that I have read and agree to the ISA Declaration.

Products and Services

I intend to trade stocks and shares

I intend to trade CFD/Derivatives

Your Personal Information

Name as on passport

Forenames *

Surname *

Gender *

Male

Female

Date of Birth *

Town of Birth

Nationality *

National Insurance No. *

Address *

Address

Address Line 1

Address Line 2

Town/City

County

Postcode

Which countries are you resident in for tax purposes? *

Please list all

Contact Details

Primary Telephone Number *

Including country and area code

Secondary Telephone Number

Including country and area code

Email Address *

Investment

Anticipated initial investment *

Bank Account Details

Name of Account *

Sort Code *

Account Number *

Declarations

Data Protection

To comply with the UK Money Laundering Regulations, we are required to collect information about you and to undertake checks on your identity and residential address, including accessing and using information held in database or other electronic format through other agencies. We may also request further supporting documentation from you to verify these details. Your information may be disclosed to law enforcement agencies and other relevant organisations for crime detection and prevention purposes. We will add your personal data and details (including email details) to our database.

If you do not consent to the use of your personal data in this way, we are unable to consider your application. By submitting the completed application form to us, you consent to the use of your information as indicated.

Declaration

I declare that:

I understood the nature and the risk of the product(s) that I intended to trade in this account;
I act in my name as specified on this application form and not on behalf of another party in respect of all matters related to this
account. Accordingly, all funds to be deposited and transacted on the account are my own funds;
I am not aware that I have any health or other conditions that may affect the proper operation of the account;
I have provided true, accurate and complete information and undertake to update Collins Sarri Statham Investments Ltd of any changes to
the information provided without delay;
I accept that in certain circumstances Collins Sarri Statham Investments Ltd will be obliged to share information with UK tax
authorities, who may pass it on to other tax authorities.
I have, read and understood the following:
- Order Execution Policy,
- Conflict of Interest Policy,
- The fees and charges summary
- The client agreement
I consent to the Order Execution Policy and for any orders to be executed outside a regulated market or a multilateral trading facility;·
I consent for any unexecuted limit orders not to be made public; and
I accept and agree to be bound by the terms provided above and consent to such terms and information including future updates to these be
provided to me.

Are you a Politically Exposed Person (PEP)?*

Yes

No

Are you connected to a PEP?**

Yes

No

*Politically Exposed Person (PEP) means a natural person who is or who has been entrusted with prominent public functions and includes the following:

A. Heads of State, heads of government, ministers and deputy or assistant ministers.
B. Members of parliament or of similar legislative bodies.
C. Members of the governing bodies of political parties.
D. Members of supreme courts, of constitutional courts or of other high-level judicial bodies, the decisions of which are not subject to further appeal, except in exceptional circumstances.
E. Members of courts of auditors or of the boards of central banks.
F. Ambassadors, chargés d'affaires and high-ranking officers in the armed forces.
G. Members of the administrative, management or supervisory bodies of State-owned enterprises.

**Connected to a Politically Exposed Person (PEP) means family members and close associates Family members includes the following:

A. The spouse, or a person considered to be equivalent to a spouse, of a politically exposed person.
B. The children and their spouses, or persons considered to be equivalent to a spouse, of a politically exposed person.
C. The parents of a politically exposed person.

Persons known to be close associates' means:

A. Natural persons who are known to have joint beneficial ownership of legal entities or legal arrangements, or any other close business relations, with a politically exposed person.
B. Natural persons who have sole beneficial ownership of a legal entity or legal arrangement which is known to have been set up or the de facto benefit of a politically exposed person.

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