Alliance Growth Capital - Application Form

Account Application

Alliance Growth Capital is Incorporated
Broker's Name

First NameLast Name
Account Number
Account Type

IndividualJointCorporate
Primary Account Holder Information
Title

Mr.Mrs.MissOthers
If Others, Please Specify
Preferred Title
First Name
First Name
Middle Name
Middle Name
Last Name
Last Name
Please check your preferred address for all Alliance Growth Capital legal documents and shares registration.
Home AddressCompany Address
Company Name
(Please indicate if you checked Company Address)
Street Number and Name
Street Address
Town/District
Name of Town or District
City
Name of City
Post Code
Post or Zip Code
Country
Name of Country
Main Contact Information
Home Number
Business Number
Mobile Number
Fax Number
Email Address
example@example.com
Alternative Contact Number
Home Number
Business Number
Mobile Number
Fax Number
Email
example@example.com
Please indicate preferred time to take a call.

MorningAfternoonEvening
PRIMARY ACCOUNT HOLDER INFORMATION

In compliance with the Anti-Money Laundering guidelines, you are required to complete the information asked below.
Date of Birth

MonthDayYear
Date
Place of Birth
Birth Place
Nationality
Nationality
Country of Citizenship
Citizenship
Driver's License Number
Driver's License
Passport Number
Passport Number
Marital Status

UnmarriedMarriedDivorcedSeparatedWidowed
Employment Status

Self EmployedEmployedNot EmployedCompany/Business OwnerRetired
Primary Occupation
Occupation
Trading Experience

(Please check appropriate box.)
Stocks

NoneLess Than 1 Year1-5 Years6-10 YearsMore Than 10 Years
Bonds

NoneLess Than 1 Year1-5 Years6-10 YearsMore Than 10 Years
Mutual Funds

NoneLess Than 1 Year1-5 Years6-10 YearsMore Than 10 Years
Commodities

NoneLess Than 1 Year1-5 Years6-10 YearsMore Than 10 Years
Features

NoneLess Than 1 Year1-5 Years6-10 YearsMore Than 10 Years
Options

NoneLess Than 1 Year1-5 Years6-10 YearsMore Than 10 Years
CryptoCurrencies

NoneLess Than 1 Year1-5 Years6-10 YearsMore Than 10 Years
Investment Goals

(Please check appropriate box.)
Risk Tolerance

AggressiveModerateConservative
Investment Objective

Capital GainsIncome
Financial and Investment Profile
Currency preferred for the succeeding items:

USDEUROthers
If Others, Please Specify
Currency
Annual income from all sources (Exclude income from spouse.)

Below 25,00025,000 - 99,999100,000 - 199,999200,000 - 349,999350,000 - 499,999500,000 & Above
Liquid net worth (Exclude the value of your residence and other non-liquid assets.)

Below 25,00025,000 - 99,999100,000 - 199,999200,000 - 349,999350,000 - 499,999500,000 & Above
Total net value of all assets (Exclude the value of your residence and other non-liquid assets.)

Below 25,00025,000 - 99,999100,000 - 199,999200,000 - 349,999350,000 - 499,999500,000 & Above
Primary source of income

SalaryInvestmentRetirement
Are you affiliated with or employed by a stock exchange or member firm of an exchange or FINRA, or a municipal securities broker-dealers?

YesNo
Are you a director, 10% shareholder or policy-making officer of a publicly held company?

YesNo
If Yes, Please Specify
Company or Business Name
Current or former senior official of a foreign government or political party, or senior executive of a foreign government-owned commercial enterprise, or a family member of close associate of such person.

YesNo
Name of Broker / Dealer (s) where you have had Securities Accounts in the last 5years:
Name of Broker or Dealer
Name of FCM (s) where you have had Future Accounts in the last 5 years:
Name of FCM(s)
Secondary Account Holder Information
Title

Mr.Mrs.MissOthers
If Others, Please Specify
Preferred Title
First Name
First Name
Middle Name
Middle Name
Last Name
Last Name
Please check your preferred address for all Alliance Growth Capital legal documents and shares registration.
Home AddressCompany Address
Company Name
(Please indicate if you checked Company Address)
Street Number and Name
Street Address
Town/District
Name of Town or District
City
Name of City
Post Code
Post or Zip Code
Country
Name of Country
Secondary Contact Information
Home Number
Business Number
Mobile Number
Fax Number
Email Address
example@example.com
Alternative Contact Number
Home Number
Business Number
Mobile Number
Fax Number
Email
example@example.com
Please indicate preferred time to take a call.

MorningAfternoonEvening
SECONDARY ACCOUNT HOLDER INFORMATION

In compliance with the Anti-Money Laundering guidelines, you are required to complete the information asked below.
Date of Birth

MonthDayYear
Date
Place of Birth
Birth Place
Nationality
Nationality
Country of Citizenship
Citizenship
Driver's License Number
Driver's License
Passport Number
Passport Number
Marital Status

UnmarriedMarriedDivorcedSeparatedWidowed
Employment Status

Self EmployedEmployedNot EmployedCompany/Business OwnerRetired
Primary Occupation
Occupation
Trading Experience

(Please check appropriate box.)
Stocks

NoneLess Than 1 Year1-5 Years6-10 YearsMore Than 10 Years
Bonds

NoneLess Than 1 Year1-5 Years6-10 YearsMore Than 10 Years
Mutual Funds

NoneLess Than 1 Year1-5 Years6-10 YearsMore Than 10 Years
Commodities

NoneLess Than 1 Year1-5 Years6-10 YearsMore Than 10 Years
Features

NoneLess Than 1 Year1-5 Years6-10 YearsMore Than 10 Years
Options

NoneLess Than 1 Year1-5 Years6-10 YearsMore Than 10 Years
CryptoCurrencies

NoneLess Than 1 Year1-5 Years6-10 YearsMore Than 10 Years
Investment Goals

(Please check appropriate box.)
Risk Tolerance

AggressiveModerateConservative
Investment Objective

Capital GainsIncome
Financial and Investment Profile
Currency preferred for the succeeding items:

USDEUROthers
If Others, Please Specify
Currency
Annual income from all sources (Exclude income from spouse.)

Below 25,00025,000 - 99,999100,000 - 199,999200,000 - 349,999350,000 - 499,999500,000 & Above
Liquid net worth (Exclude the value of your residence and other non-liquid assets.)

Below 25,00025,000 - 99,999100,000 - 199,999200,000 - 349,999350,000 - 499,999500,000 & Above
Total net value of all assets (Exclude the value of your residence and other non-liquid assets.)

Below 25,00025,000 - 99,999100,000 - 199,999200,000 - 349,999350,000 - 499,999500,000 & Above
Primary source of income

SalaryInvestmentRetirement
Are you affiliated with or employed by a stock exchange or member firm of an exchange or FINRA, or a municipal securities broker-dealers?

YesNo
Are you a director, 10% shareholder or policy-making officer of a publicly held company?

YesNo
If Yes, Please Specify
Company or Business Name
Current or former senior official of a foreign government or political party, or senior executive of a foreign government-owned commercial enterprise, or a family member of close associate of such person.

YesNo
Name of Broker / Dealer (s) where you have had Securities Accounts in the last 5years:
Name of Broker or Dealer
Name of FCM(s) where you have had Future Accounts in the last 5 years:
Name of FCM(s)
AGREEMENT
I. Contained in this agreement are the terms applicable to the account owner named on this account application (client) for purchasing and selling of stocks, bonds, services and private placements by Alliance Growth Capital.

II. Transactions made on behalf of the client are subject to regulations, rules, by-laws, constitution, and normal industry practice relating to the exchanges/clearing houses. Client acknowledges that securities will fluctuate in value depending upon market conditions.

III. Instruction from client will be whether verbal or written concerning transactions that Alliance Growth Capital will carry out on behalf of client.

IV. All written correspondences to client shall be accepted as accurate, unless written objection is immediate, or not longer than 3 working days from initial receipt, sent to Alliance Growth Capital by electronic mail. All confirmations of trading transactions will be sent by fax or electronic mail (email). Ordinary correspondence will be sent by electronic mail (email). Any change of client’s mailing address must be notified to Alliance Growth Capital in writing. Currency “Slip” notices (buy/sell order or trade confirmation) are quoted in the currency applicable to country where the shares are traded.

V. Alliance Growth Capital is not responsible in any way for any losses and/or damages suffered by exchange rate fluctuations.

VI. The “trading account- Client Agreement” can be terminated by Alliance Growth Capital or client within thirty days period in writing only with the commencement date the receiving time of the written notice by the party causing/ requesting the termination. When such period is expired, Alliance Growth Capital has obligation to send client any proceeds of sales made under “best effort” situation, or actual certificates.
PRINTED NAME & SIGNATURE
(Primary Account Holder)
Signature

Clear
PRINTED NAME & SIGNATURE
(Secondary Account Holder-For Joint Accounts only.)
Signature

Clear
DISCLOSURE POLICY
The non-public personal information we collect about you comes primarily from this account application or other forms you submit to us. We do not disclose your information to anyone, except as permitted by law. All client information will be treated in strictest confidence. It may only include disclosing your information pursuant to your express consent, to fulfill your instructions, or to comply with applicable laws and regulations. We limit access to your information to those of our employees and service providers who are involved in offering or administering the products or services that we offer. We maintain physical, electronic, and procedural safeguards that are designed to comply with international standards to guard your information. If our relationship is terminated, we will continue to treat the information as stated herein.
Should be Empty:

Account Application

Primary Account Holder Information

Please check your preferred address for all Alliance Growth Capital legal documents and shares registration.

Main Contact Information

Alternative Contact Number

PRIMARY ACCOUNT HOLDER INFORMATION

Trading Experience

Investment Goals

Financial and Investment Profile

Secondary Account Holder Information

Please check your preferred address for all Alliance Growth Capital legal documents and shares registration.

Secondary Contact Information

Alternative Contact Number

SECONDARY ACCOUNT HOLDER INFORMATION

Trading Experience

Investment Goals

Financial and Investment Profile

AGREEMENT

DISCLOSURE POLICY