Date: _______________ To: Easy Forex Ltd.

(the “Company”) Re: Authorization to perform Withdrawals Whereas I, the undersigned, have an account registered in my name with the Company (the “Account”); read and fully understand and accept the terms and conditions of activity in the Account, as appeared on the Company’s web site (www.Easy-Forex.com or any other web site of the Easy Forex group); 1. I hereby authorize the Company to withdraw from the Account any amount and/or transfer such amount to my account in accordance with the terms and conditions of the Company and/or perform any action regarding such amount, all - according to my instructions to be provided to the Company by myself, from time to time (the “Withdrawals”); I hereby waive any claim towards the Company regarding the Company’s activity according to my instructions and the information provided by me. 2. I hereby waive any claim and/or suit with regard to the Company’s actions according to this authorization, and exempt the Company from any liability to any damage and/or cost, if any, as a result of this authorization and/or the Company’s actions according to it. 3. I agree that the Company is entitled on its sole discretion to require me to sign specific withdrawal forms which may change from time to time, with regard to any given withdrawal (the “Form”). I undertake that the Company may decide not to perform any Withdrawal, on its sole discretion, prior to me signing such Form and providing the Company with the signed Form and/or any other information it may require. 4. I am aware that the amounts withdrawn are “gross amounts”, from which the Company may deduct taxes, as may be required by applicable law, and I shall have no claim towards the Company with regard to such deductions. 5. In this authorization, the “Company” shall mean the Company, any subsidiary and/or Parent Company, as well as any of the Company’s shareholders, directors, executives, employees and/or any other third party acting on the Company’s behalf. 6. I hereby confirm that I have been using the following credit cards for depositing funds to Easy Forex Ltd:
Name On Credit Card Credit Card # Expiry Type (Visa / MC / AmEx, etc.)

For Withdrawals to a bank account please send a SWIFT confirmation as per original deposit with the full Bank details.
Name User Name Telephone

Full Address

Passport No.

Name:

Date:

Signature:

Signer MUST attach a PHOTO IDENTIFICATION (Passport / ID) to the Form and fax to: (+357) 25 817 183 or: Scan the Form and the ID and e-Mail the file(s) to: WDF-c@Easy-Forex.com
Easy-Forex™ Trading Platform / Forms 12-2006 V8