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Banker Onboarding Form

Full Name

Date of Birth

Country of Residence

Country of Citizenship

Professional Headhsot

Image of Passport

Other names you have been known by or which you have used, if any, say none if none

Are you a resident of the United States?

Are you a resident of the United States?
A
B

Are you a registered person of any US regulated broker dealer?

Are you a registered person of any US regulated broker dealer?
A
B

List any FINRA licences you hold, say none if none

Have you ever been the subject of a disciplinary event as follows?

1) Denied membership, licensing or registration in any U.S. or non-U.S. broker-dealer or banking association, organization, or exchange?

1) Denied membership, licensing or registration in any U.S. or non-U.S. broker-dealer or banking association, organization, or exchange?
A
B

2) Suspended or expelled from any U.S. or non-U.S. national securities association or exchange, barred or suspended from association with a U.S. or non-U.S. broker-dealer or bank, or had your membership revoked from a U.S. or non-U.S. national securities association or exchange?

2) Suspended or expelled from any U.S. or non-U.S. national securities association or exchange, barred or suspended from association with a U.S. or non-U.S. broker-dealer or bank, or had your membership revoked from a U.S. or non-U.S. national securities association or exchange?
A
B

3) Subject to disciplinary action or sanctions by any securities authority or financial regulator in the United States or outside the United States?

3) Subject to disciplinary action or sanctions by any securities authority or financial regulator in the United States or outside the United States?
A
B

4) Associated with any U.S. or non-U.S. broker-dealer or bank that during the time of your association had been denied, suspended, expelled or revoked of membership or registration from an association or exchange?

4) Associated with any U.S. or non-U.S. broker-dealer or bank that during the time of your association had been denied, suspended, expelled or revoked of membership or registration from an association or exchange?
A
B

5) Associated with any U.S. or non-U.S. broker-dealer or bank that during the time of your association had any permanent or temporary injunction entered against it by an association or exchange?

5) Associated with any U.S. or non-U.S. broker-dealer or bank that during the time of your association had any permanent or temporary injunction entered against it by an association or exchange?
A
B

6) Subject in the U.S. or outside the U.S. to any temporary or permanent injunctions or other judicial sanctions pertaining to financial services, investments, securities, commodities, banking, insurance, real estate, fraud, false statements or omissions, wrongful taking of property, bribery, forgery, counterfeiting, or extortion?

6) Subject in the U.S. or outside the U.S. to any temporary or permanent injunctions or other judicial sanctions pertaining to financial services, investments, securities, commodities, banking, insurance, real estate, fraud, false statements or omissions, wrongful taking of property, bribery, forgery, counterfeiting, or extortion?
A
B

7) Arrested, charged or indicted in the U.S. or outside the U.S. for any felony, misdemeanour, or other criminal offence pertaining to financial services, investments, securities, commodities, banking, insurance, real estate, fraud, false statements or omissions, wrongful taking of property, bribery, forgery, counterfeiting, or extortion?

7) Arrested, charged or indicted in the U.S. or outside the U.S. for any felony, misdemeanour, or other criminal offence pertaining to financial services, investments, securities, commodities, banking, insurance, real estate, fraud, false statements or omissions, wrongful taking of property, bribery, forgery, counterfeiting, or extortion?
A
B

8) Made any false or misleading statements with respect to any material fact, or omitted to state any material facts, in any such application, report, or proceeding concerning professional registration or licensing or membership of a broker-dealer or banking association or organization in the United States or outside the United States?

8) Made any false or misleading statements with respect to any material fact, or omitted to state any material facts, in any such application, report, or proceeding concerning professional registration or licensing or membership of a broker-dealer or banking association or organization in the United States or outside the United States?
A
B