R

Cantor Fitzgerald Ireland Ltd (“Cantor”)

Advisory Joint/Individual Account
Client Information/Update Form
Completion of Form For regulatory purposes and to provide you with appropriate advice, we ask that you
complete the form below in full and with due care and attention.
Please answer all questions.

Where the question is not applicable to your circumstances, please respond “0”
(where numeric information is requested) or “n/a” (for all others).
Estimates are sufficient where financial information is requested.

Post/Delivery Please return completed form to:

Cantor Fitzgerald Ireland Ltd
75 St Stephen’s Green
Dublin 2

Queries/Advice Please call our dedicated support line on +353 1 633 3607
on completion
of this form

Please add your existing account number below:

Account Number:

www.cantorfitzgerald.ie

ASCU0/4
Advisory Joint/Individual Account R

Client Information/Update Form

1. Personal Details (PLEASE USE BLOCK CAPITALS)

Self Second party if joint account
Title Mr Mrs Ms Miss Title Mr Mrs Ms Miss

Surname Surname

Forename(s) Forename(s)

PPS Number PPS Number

Date of Birth DD MM YY Date of Birth DD MM YY

Place of Birth Place of Birth

Nationality Nationality

Provisional retirement date (if known) DD MM YY Provisional retirement date (if known) DD MM YY

2. Contact Details (PLEASE USE BLOCK CAPITALS)

Self Second party if joint account

Telephone Numbers and Email Address Telephone Numbers and Email Address

Home Home

Mobile Mobile

Office Office

Fax Fax

Email Email

For correspondence purposes, Cantor will use the email address of the first party.

For regulatory reasons and to provide clients with appropriate advice we ask that you complete the following

Please provide best estimates for the financial information requested. Please complete all sections. Where a section is not applicable
to your circumstances please insert "0".

3. Financial Background (PLEASE USE BLOCK CAPITALS)

Regular Income
Self Second Party (if joint account)

Income from employment/pension € p.a. € p.a.

Net income from investments
other than property € p.a. € p.a.

Net income from property € p.a. € p.a.

Other Net Income € p.a. € p.a.

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Advisory Joint/Individual Account R

Client Information/Update Form

For regulatory reasons and to provide clients with appropriate advice we ask that you complete the following

3. Financial Background CONTINUED

Regular Commitments

Pension Contribution € p.a. € p.a.

Mortgage (for PPR*)

* Principal Private Residence € p.a. € p.a.
Estimated other commitments
e.g. other loan payments € p.a. € p.a.

Occupation & Employment Capacity

Self Second Party (if joint account)

Occupation .

Employment Capacity Self-employed / Director Self-employed / Director

Company Employee Company Employee
Retired Retired

Value of Personal Assets (Joint)

Principal Private Residence (PPR) €

Mortgage on PPR €

Cash Deposits €

Other Investments €

Gross Value other properties €

Total Debt on other properties/investments €

Other net assets €

Source of Wealth/Funds
Please indicate your source of wealth (this refers to how you have accumulated your wealth), you may indicate more than one option
Salary/Bonus Inheritance Savings Sale of Shares
Sale of Property Other

If other please specify:

Please indicate your source of funds (this refers to the funds being transfered for investment with Cantor), you may indicate more than one option
Maturing Deposit Savings Account Transfer from other investment provider
Proceeds of asset sale Other

If other please specify:

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Advisory Joint/Individual Account R

Client Information/Update Form

4. Investment Objectives and Risk

A. Portfolio Individual Transaction Size
What is your anticipated total portfolio size
Less than €20,000 Between €20,000 and €50,000 Between €50,000 and €150,000
Between €150,000 and €500,000 Over €500,000

Is this typical of your previous portfolio size? Yes No If no, please indicate previous portfolio size €
What is your average anticipated transaction size
Less than €10,000 Between €10,000 and €50,000 Between €50,000 and €250,000
Over €250,000

Is this typical of your previous transaction size Yes No If no, please indicate previous transaction size €
B. Time Horizon
If you have a specific investment time horizon for your account please indicate below
Less than 1 year Between 1 and 5 years Over 5 years
C. Income Requirement
Please state the approximate income requirement, if any, from your investment with Cantor €
D. Which of the following best describes your investment objective
Capital Growth only Mix of Income with Capital Growth Income only

E. Permitted Investment Instruments

Please tick which instruments you would consider investing in, you may indicate more than one option
Equities Structured or non-quoted investments Investment Fund
Government Bonds Corporate Bonds Derivatives including CFDs*

Other, please specify

*Please note if you are investing in CFDs or Derivatives your account type will automatically be designated a risk taker.

F. Attitude to Risk
(i) Which of the following most accurately describes your investment/risk profile?
Very Cautious Investor
You are risk averse. Your investment preference is to maintain the security of your capital. You acknowledge that this investment
strategy is at the expense of potential capital gain or incremental income.
Cautious Investor
You are prepared to accept low levels of risk for the prospect of slightly higher returns.
Considered Investor
You are looking for a balance of risk and reward. You accept during periods of market risk potential losses may exceed by a
multiple the potential income from investments.
Considered Risk Taker
You are willing to accept higher levels of volatility and fluctuations in the value of your investments for the prospect of higher
returns. You accept that volatility in markets may result in loss in excess of the initial investment amount.
Risk Taker
You are willing to accept high volatility levels and fluctuations in the value of your investments for the prospect of higher returns.
You acknowledge that in light of the unpredictable nature of stock markets your investment may carry an increased risk of
potential loss in excess of the initial amount invested.
(ii) You find it interesting to explore investment opportunities for your money?
Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree

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Client Information/Update Form

4. Investment Objectives and Risk continued

(iii) Six months after making an investment where your capital is at risk, your investment performs poorly in line with
weak financial markets. Which option described below, best suggests your possible course of action?
Sell all the investment and put the proceeds in a deposit account to prevent further loss
Sell part of the investment, purchasing a less risky investment with the proceeds to reduce further losses
Monitor the investment ahead of deciding what to do
Invest more monies to avail of weaker prices expecting recovery
Make a riskier investment to recover all losses in the expectation of recovery

5. Experience
Basic: Have some knowledge but limited trading history.
Good: Have knowledge and have traded over a number of years.
Extensive: Have knowledge and have traded consistently over the past 5 years.
A. Financial Instruments
Please indicate your investment experience in relation to the following instruments:
NONE BASIC GOOD EXTENSIVE NUMBER OF YEARS NUMBER OF TRADES
EXPERIENCE PER ANNUM
Equities

Corporate Bonds
Government Bonds
Investment Funds
Structured or
non-quoted investments

Where you have dealt previously has this service been primarily
Execution Only (no broker input) Advisory (broker advises you decide)
Discretionary/managed (broker agrees investment parameters and has discretion to transact)

B. Derivatives
You would consider using derivatives
For hedging - to reduce risk or increase income but not as a tool to increase risk. Yes No
For speculation - understanding that you may lose part or all of your capital so invested. Yes No
Please indicate your investment experience in relation to the following instruments:
NONE BASIC GOOD EXTENSIVE NUMBER OF YEARS NUMBER OF TRADES
EXPERIENCE PER ANNUM
CFDs

Options
Futures

Where you have dealt previously has this service been primarily
Execution Only Advisory Discretionary/managed
Relevant Experience
Do you have a professional qualification, work as an investment manager or adviser, or are a member
of a recognised investment association? Yes No

If yes please provide details

Is there any other reason why we should deem you to be a professional investor

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Advisory Joint/Individual Account R

Client Information/Update Form

6. Individual (Controlling Person’s) Self-Certification for FATCA and CRS

Instructions for completion
We are obliged under Section 891E, Section 891F and Section 891G of the Taxes Consolidation Act 1997 (as amended) and
regulations made pursuant to those sections to collect certain information about each investor’s tax arrangements. Please complete
the sections below as directed and provide any additional information that is requested. Please note that in certain circumstances we
may be legally obliged to share this information, and other financial information with respect to an investor’s interests in the Fund
with relevant tax authorities .This form is intended to request information only where such request is not prohibited by Irish law.
If you have any questions about this form or defining the investor’s tax residency status, please refer to the OECD CRS Portal or
speak to a tax adviser.
For further information on FATCA or CRS please refer to Irish Revenue website at http://www.revenue.ie/en/business/aeoi/index.html
or the following link to the OECD CRS Information Portal at:
http://www.oecd.org/tax/automatic-exchange/ in the case of CRS only.
If any of the information below about the investor’s tax residence or FATCA/CRS classification changes in the future, please advise of
these changes promptly.
Please note that where there are joint or multiple account holders each investor is required to complete a separate Self-Certification
form.
FATCA Declaration of U.S. Citizenship or U.S. Residence for Tax purposes:
By opening this account and signing below, the account owner represents and warrants that he/she/it is not a US person for the
purposes of US Federal income tax and that he/she/it is not acting for, or on behalf of, a US person. A false statement or
misrepresentation of tax status by a US person could lead to penalties under US law. If your tax status change or you become a US
citizen or a resident, you must notify us within 30 days.
CRS Declaration of Tax Residency (please note you may choose more than one country):
Please indicate your country of tax residence (if resident in more than one country please detail all countries of tax residence and
associated taxpayer identification numbers (“TIN”). Please see the CRS Portal for more information on Tax Residency. NOTE: Provision
of a Tax ID number (TIN) is required unless you are tax resident in a Jurisdiction that does not issue a TIN.
Self: Second party (if joint account):
Country Of Tax Residency Tax ID Number (e.g. PPS) Country Of Tax Residency Tax ID Number (e.g. PPS)

Declaration and Undertakings:

I declare that the information provided in this form is, to the best of my knowledge and belief, accurate and complete. I
acknowledge that the information contained in this form and information regarding the Account Holder may be reported to the tax
authorities of the country in which this account(s) is/are maintained and exchanged with tax authorities of another country or
countries in which the Account Holder may be tax resident where those countries (or tax authorities in those countries) have entered
into Agreements to exchange financial account information. I undertake to advise the recipient promptly and provide an updated
Self-Certification form where any change in circumstances occurs which causes any of the information contained in this form to be
incorrect.
Authorised Signature Authorised Joint Signature (if joint account)

Print Name Print Name

DD MM YY DD MM YY
Date Signed Date Signed

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Advisory Joint/Individual Account R

Client Information/Update Form

7. Consent

Please tick to acknowledge you have read and agreed to the below:

In signing this document you are providing Cantor with your express prior consent: where highlighted on the attached.

To execute trades on your behalf outside a regulated market or multilateral trading facility* in the European Economic Area.

Not to display your unfilled limit orders in a public forum unless you specifically instruct us otherwise.

*Multilateral trading facility (MTF) – is, broad terms, a system that brings together multiple parties (e.g. retail investors or other
investment firms) that are interested in buying and selling financial instruments and enables them to do so. These systems can be
crossing networks or matching engines that are operated by an investment firm or a market operator. Instruments may include
shares , bonds and derivatives. This is done within the MTF operator’s system. E.g. Alternative Investment Market (AIM).

8. Acknowledgement
In signing this document you are confirming that the information provided is complete and accurate. Furthermore you undertake to
advise Cantor should this information change
Client Acceptance

Account No:
Signature Joint Signature (where appropriate)

Print Name Print Name

DD MM YY DD MM YY
Date Date

75 St. Stephen’s Green, Dublin 2, Ireland. Tel : +353 1 633 3800. Fax : +353 1 633 3856
email : [email protected] web : www.cantorfitzgerald.ie

Cantor Fitzgerald Ireland Ltd is regulated by the Central Bank of Ireland. Cantor Fitzgerald Ireland Ltd is a member firm of the Irish Stock Exchange and the London Stock Exchange.

MARCH 2016
Advisory Joint/Individual Account R

Client Information/Update Form

Broker Confirmation

When information is taken over a recorded line by broker:

Signed (broker)

Name (broker)

Time Stamp

Client Email

When information is provided at a meeting with your client:

Signed (broker)

Name (broker)

Date DD MM YY

Client Email

75 St. Stephen’s Green, Dublin 2, Ireland. Tel : +353 1 633 3800. Fax : +353 1 633 3856
email : [email protected] web : www.cantorfitzgerald.ie

Cantor Fitzgerald Ireland Ltd is regulated by the Central Bank of Ireland. Cantor Fitzgerald Ireland Ltd is a member firm of the Irish Stock Exchange and the London Stock Exchange.

MARCH 2016