SOURCE AND USE OF FUNDS INFORMATION

In accordance with the requirements of current anti-money laundering, counter terrorist financing, and sanctions legislation, we are required
to establish and record evidence of the identity and source of funds for all of our verified clients before establishing a business relationship. In
addition, we are also required to determine that the account is not being opened and will not be operated for the benefit of a third party. Best
AML/CTF practices require that we implement ongoing monitoring of all customer transactions and identities. You may be subject to follow up
questions and enhanced customer due diligence procedures at any time. Failure to satisfactorily address any outstanding issues or questions
can result in, among other things, termination of access to your account and termination of our services to you.
Upon completion of this form, please print, sign and send scanned copies of all documents to: COMPLIANCE@BITFINEX.COM Thank you.

CUSTOMER INFORMATION

Username Last Name

First Name Middle Name

SOURCE AND USE OF FUNDS INFORMATION

Current Employment Status: Employer Information:

□ Employed Job Title/ Description

□ Self-Employed Industry
□ Not Employed Employer Name
□ Student
□ Retired Employer Address

Net Worth US Dollars: Expected Level of Investments:

Source of Funds:
(Not Including Primary Residence) (US Dollars per month)

□ Salary □ 0－20,000 □ 0－20,000

□ Savings □ 20,001－50,000 □ 20,001－50,000
□ 50,001－100,000 □ 50,001－100,000
□ Investments □ 100,001－250,000 □ >100,000
□ 250,001－500,000
□ Inheritance □ 500,001－1,000,000
□ Other; Please Specify: □ 1,000,001－3,000,000
□ 3,000,001－5,000,000
□ >5,000,000
INVESTMENT EXPERIENCE

Have you invested in the Stock Market before? □ Yes □ No

Investment Experience into Equities (number of years)

Do You Understand How Derivatives Work? □ Yes □ No

Investment Experience into Derivatives Markets (number of years)

Do You Understand You Are Taking Significant Risk Trading Cryptocurrencies? □ Yes □ No
DECLARATION
I do hereby solemnly declare that the information provided is up-to-date and correct. I authorize BITFINEX to verify the information provided on this
form to confirm its accuracy.

Applicant Signature: Date: