*Tradedsia crac In compliance with FATCA and os enacted bythe US. government, all 2TradeAsa Account Applications must submit a filed out FATCA form. ‘Kindly answer the following questionnaire and provide addtional documents if applicable PRIMARY ACCOUNT. | SECONDARY ACCOUNT HOLDER HOLDER ‘Are you aUS citizen? Cv Cine | Che Lno ‘Ave you a dual citizen? (lick Yesf one ofthe counties of izenshipis the US) Lvs Ono | Dre Bo ‘Are you a permanent resident of the US. / green card holder? Lvs Ono | Che Lno ‘re you born in the US.? Cv Cno | Ces Eno Do you have a residence in the US? Ove Go | Dre Bo Do you have a phone number in the US? Dives Ono | Dre Bro Do you have any instructions to transfer funds to an account in the US? Cv Ono | Ces Cro Have you ever been to the US inthe last 6 months? Dvs Ono | Ces Ono Ifany of the answers to questions stated above is YES, kindly specify required applicable information below: PRIMARY ACCOUNT HOLDER SECONDARY ACCOUNT HOLDER US. Address US. Address Us.tel Ne. US.Tel No, US.P0. Box [Us TNNe, US... Box US.TWNe, Standing instrocions te pay aout Arenal funda te an account maintaved | Standing mctrucons te pay anwunthransfer funds te an account mamtamed [current power of attorney or ignatory authority ranted to@ lus Address JUS Address: jdrezcor"hold mall” address Anvin-care-of” addres or-hold mall a [anln-care-of" Tength of stay in US Tength ofstay in Us ttn aer ra anarogatons wih mayb aces ego ances mgt oder he Pipes rh ser gn acne vse acesny nts conto ny act Printed Name & Signature Date Signed Printed Name & Signature Date Signed (Secondary Account Holder)