You are on page 1of 6

TD Direct Investing International Copy

Please return to:


TD Bank International
46a, avenue J.F. Kennedy,
L-2958 Luxembourg
Luxembourg

APPLICATION SUMMARY

To finalise your request to open an account at TD Direct Investing International, please:


Return and sign your application summary.
We will later provide you with the initial bank transfer instructions to validate your identity.
Include a high quality copy of your passport/EU National Identity Card including signature page.
Include a W-8BEN form if you intend to trade US stocks

Your Details
Reference number:

9ST99MJR

Full name:

Mr Mohamed Diaa El Din Mortada

Date of birth:

5 Mar 1961

Citizen of:

Egypt

Residency address:

53-3-1 El Rahab City Cairo Egypt


Cairo
56497
Egypt

Preferred mailing address:

53-3-1 El Rahab city Cairo Egypt


Egypt
56497
Egypt

Email address:

mdiaamortada@gmail.com

Page 1 of 2

www.tddirectinvesting.lu | +352 2603 2003

TD Direct Investing International Copy


Please return to:
TD Bank International
46a, avenue J.F. Kennedy,
L-2958 Luxembourg
Luxembourg

APPLICATION SUMMARY

I/We hereby declare that: I/We apply to enter into a business relationship with TD Bank International S.A. by the opening of the above
mentioned account.
I/We confirm all of the information provided beforehand and also on-line is complete, true and accurate and that I/we will inform TD
Bank International S.A. immediately of any changes in my/our personal data and in my/our investment profile, especially concerning
my/our residency, nationality, profession and employer.
I/We fully certify under penalties of perjury that I/we am/are the beneficial owner(s) of all the assets entrusted to TD Bank
International S.A. and income to which this form relates.
I/We expressly acknowledge that TD Bank International S.A. offers no personal investment recommendations or advisory service,
and that in case of a question or a query about a transaction I/we am/are considering, I/we should consult with a qualified financial
or/and legal advisor.
I/We expressly acknowledge that TD Bank International S.A. shall not be obliged to open the account for any reason whatsoever, and
notably if the information provided is not complete, TD Bank International S.A. may request any other document that it deems
necessary.
I/We expressly acknowledge that TD Bank International S.A. will not authorise any transaction until formal confirmation of the
acceptance of the account opening by the Bank.
I/We confirm by returning this application form via post to TD Direct Investing International's postal address, that I/we have fully
understood, and accepted the contents of the following documents, which I/ we have read via the on-line application form. These
documents are available and downloadable on-line via the Investor Services section of the TD Direct Investing International website:
Application Brochure available at http://www.tddirectinvesting.lu/en-gb/~/media/td-bankinternational/forms/application_form.ashx
Commissions and rates available at http://www.tddirectinvesting.lu/en-gb/investment-products/fees-and-commissions/
Terms and Conditions available at http://www.tddirectinvesting.lu/en-gb/~/media/td-bankinternational/forms/terms_and_conditions.ashx
General Risk Warning Notice available at http://www.tddirectinvesting.lu/en-gb/~/media/td-bankinternational/forms/risk_warning_notice_general.ashx
Derivatives Risk Warning Notice available at http://www.tddirectinvesting.lu/en-gb/~/media/td-bankinternational/forms/risk_warning_notice_derivatives.ashx

Mr Mohamed Diaa El Din Mortada

Date and Place:

Signature:

Page 2 of 2

www.tddirectinvesting.lu | +352 2603 2003

Certificate of Foreign Status


of Beneficial Owner for United States Tax Withholding
> For use by Individuals only
> Section references are to the Internal Revenue Code
> For additional information on the completion of this form see the instructions
> An original completed form must be returned to us (faxes are NOT acceptable)
General Instructions This form may be completed only by or for a non resident alien individual. If you are a U.S. citizen or an alien resident
in the United States for tax purposes, do not use this form. Instead use Form W-9.

PART 1: IDENTIFICATION OF BENEFICIAL OWNER (see instructions)


1. Name of individual that is the beneficial owner

2. Country of incorporation or organization


NOT APPLICABLE

3. Type of beneficial owner:


X Individual

Corporation

Grantor trust

Tax-exempt organization

Complex trust

Central bank of issue

Simple trust

Private foundation

Disregarded entity

Government

Partnership

Estate

International organization

4. Permanent residence address (street, apt or suite no.) DO NOT USE A P.O. BOX OR IN CARE OF ADDRESS

City or town, state province (include postcode where appropriate)


Country (do not abbreviate)
5. Mailing address (if different from your permanent residence)

City or town, state or province (include postcode where appropriate)


Country (do not abbreviate)
6. US Taxpayer Identification No. if required (see instructions)
SSN or ITIN

7. Foreign Tax No.

8. Account No.

EIN

PART 2: CLAIM OF TAX TREATY BENEFITS (if applicable)


9. I certify that (tick all that apply)
a

The beneficial owner is a resident of __________________________ within the meaning of the income tax treaty between the United States and that country

If required, the US taxpayer identification number is stated on line 6 (see instructions)

PART 3: CERTIFICATION
Under the penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true,
correct, and complete. I further certify under penalties of perjury that:
1. I am the beneficial owner (or am authorized to sign for the beneficial owner) of all the income to which this form relates,
2. The beneficial owner is not a US person
3. The income to which this form relates is (a) not effectively connected with the conduct of a trade or business in the United States, (b) effectively connected but is
not subject to tax under an income tax treaty, or (c) the partners share of a partnerships effectively connected income, and
4. For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions
Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial owner or any
withholding agent that can disburse or make payments of the income of which I am the beneficial owner.
The Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required to establish
your status as a non-US person and, if applicable, obtain a reduced rate of withholding.

PART 4: SIGNATURE
Signature of beneficial owner
(or individual authorised to sign for beneficial owner)

Date
D D

M M

Capacity in which signing (if not beneficial owner)

Y Y Y Y

An original completed form must be returned (faxed copies are NOT acceptable)

Form W-8 BEN (Substitute)

How do I complete a W-8BEN form?


The following are information notes for the completion of a W-8BEN form. These notes should be read alongside the
official IRS instructions available at www.irs.gov
The W-8BEN form should be completed with black ink, correction fluid (Tip-ex) or correction tape should not be used. If it
is, the form will be rejected.
Part I - Identification of Beneficial Owner
Definition of Beneficial Owner - For payments other than those for which a reduced rate of withholding is claimed under an
income tax treaty, the beneficial owner of income is generally the person who is required under U.S. tax principles to include
the income in gross income on a tax return. A person is not a beneficial owner of income, however, to the extent that person
is receiving the income as a nominee, agent, or custodian, or to the extent the person is a conduit whose participation in a
transaction is disregarded. In the case of amounts paid that do not constitute income, beneficial ownership is determined as if
the payment were income
1.
4.

5.

6.

7.
8.

Enter the full name of the individual


Enter the permanent residential address. Definition of permanent residential address: Your permanent residence
address is the address in the country where you claim to be a resident for purposes of that countrys income tax. If
you are giving Form W-8BEN to claim a reduced rate of withholding under an income tax treaty, you must
determine your residency in the manner required by the treaty. Do not show the address of a financial institution, a
post office box, or an address used solely for mailing purposes. If you are an individual who does not have a tax
residence in any country, your permanent residence is where you normally reside. If you are not an individual and
you do not have a tax residence in any country, the permanent residence address is where you maintain your
principal office This does not include PO Box, Care of or any other mailing type addresses.
Country should be completed without any abbreviations used. Applicants that would enter England, Scotland,
Wales or Northern Ireland should enter United Kingdom. Jersey, Guernsey and Isle of Man are not part of the
United Kingdom.
A mailing contact address can be offered here.
Country should be completed without any abbreviations used. Applicants that would enter England, Scotland,
Wales or Northern Ireland should enter United Kingdom. Jersey, Guernsey and Isle of Man are not a part of the
United Kingdom. If you are entering a mailing address in a different country to your residency, please provide a
written explanation on a separate piece of paper (signed and dated) as the reasons and include a recent utility bills
(or medical bill or bank statement).
If the applicant has a US taxpayer identification number it should be entered here and the relevant box ticked
If you are entering a SSN number, please provide a copy of the SSN Card
If you are entering an ITIN Number, please provide a written explanation on a separate piece of paper (signed and
dated) as the reasons for the ITIN.
Only complete if one is held
This can be the account number or any other relevant reference

Part II - Claim of Tax Treaty Benefits


This section should only be completed if the applicant is resident in a country that has a tax treaty with the United states.
Tick the relevant boxes

9a. Country should be completed without any abbreviations used. Applicants that would enter England, Scotland,
Wales or Northern Ireland should enter United Kingdom. Jersey, Guernsey and Isle of Man are not part of the
United Kingdom.
9b. Only tick this if question 6 above has been answered
Part IV - Signature
Please sign and date and if relevant enter in which capacity you are signing in. Capacity examples include; beneficial owner,
power of attorney, parent and guardian.
Important Information

This is for information purposes only.

Tax advice cannot be given.

If advice is required please consult a professional tax advisor or the IRS.

Tax treaty rates do not override your actual tax liability in the country you reside but any tax withheld may be
deemed offsettable.

If you do not feel that the Form W-8BEN is appropriate, please visit www.irs.gov and review the available Form
W-8 series. Each form will have a corresponding instruction guide to help you understand the usage and
completion of the form.

CLIENT COPY
Please keep this copy
for your own records

APPLICATION SUMMARY

Application Details
Reference number:

9ST99MJR

Application type:

Individual

Existing account:

No

Contact name:

Mr Mohamed Mortada

Email address:

mdiaamortada@gmail.com

Phone number:

20 1224269451

Personal Details
Full name:

Mr Mohamed Diaa El Din Mortada

Civil status:

Separated / Divorced

Date of birth:

5 Mar 1961

Citizen of:

Egypt

Residency address:

53-3-1 El Rahab City Cairo Egypt


Cairo
56497

Country of residence:

Egypt

Preferred mailing address:

53-3-1 El Rahab city Cairo Egypt


Egypt
56497
Egypt

Email address:

mdiaamortada@gmail.com

Business phone:

20 1224269451

Home phone:

20 226072149

Mobile phone:

20 1224269451

Politically Exposed Person:

No

Hold mail:

No

1st Applicant Employment History


Status:

Full Time Employed

Employer:

Eingineer

Address:

Bani Suef
Egypt

Company activity:

Chemical industry

Job title:

Engineering Manager

Time with this employer:

3 years, 8 months

www.tddirectinvesting.lu | +352 2603 2003

CLIENT COPY
Please keep this copy
for your own records

APPLICATION SUMMARY

Financial Situation
Origin of funds:

Business Profits

Investment purpose:

Savings

Net Worth (Accumulated Wealth) in


Euros:

25,000+

Gross Annual Income in Euros:

25,000 - 100,000

Estimated trades per month:

6 - 15

Planned investment with TD Direct


Investing International:

50000

Source Of Wealth:

Property appreciation

Estimated Wire Transfers / Year:

4-6

Account funded by:

Wire

First Funding - Bank/Broker name:

CBQ

First Funding - Bank/Broker country:

Qatar

Other financial institution:

No

Investor Profile
Requested products:

Equities
Equity with Margin
Forex

Base currency:

United States Dollar (USD)

I have the following investment


experience:

Considerable experience with high-risk instruments, margin calls

Demo platform:

I will download and use the demo platform before it could go live.

1st Applicant - Proof of Identity


Proof of identity:

Bank transfer (from a Bank established in a FATF country only) and a copy of your
passport or EU ID Card (for EU nationals only)

www.tddirectinvesting.lu | +352 2603 2003