URALSIB Capital: Account Application – Account Application Form for Individuals

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Account Application Form for Individuals

Form of address :	Mr. / Ms.
Your name :
Citizenship :
Mailing address :
Phone (with country code and area code) :
Fax (with country code and area code) :
E-mail :
Are you considered a Russian resident for tax purposes
Yes No Not sure
Anticipated volume of investments :

By submitting this form I guarantee that I am an experienced investor, fully aware of all risks associated with investment in emerging markets.

I am submitting this application on my own will and not as a reply to any solicitation to enter into any transactions or to buy or sell any securities.


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