Professional Documents
Culture Documents
APPLICATION SUMMARY
Your Details
Reference number:
9ST99MJR
Full name:
Date of birth:
5 Mar 1961
Citizen of:
Egypt
Residency address:
Email address:
mdiaamortada@gmail.com
Page 1 of 2
APPLICATION SUMMARY
I/We hereby declare that: I/We apply to enter into a business relationship with TD Bank International S.A. by the opening of the above
mentioned account.
I/We confirm all of the information provided beforehand and also on-line is complete, true and accurate and that I/we will inform TD
Bank International S.A. immediately of any changes in my/our personal data and in my/our investment profile, especially concerning
my/our residency, nationality, profession and employer.
I/We fully certify under penalties of perjury that I/we am/are the beneficial owner(s) of all the assets entrusted to TD Bank
International S.A. and income to which this form relates.
I/We expressly acknowledge that TD Bank International S.A. offers no personal investment recommendations or advisory service,
and that in case of a question or a query about a transaction I/we am/are considering, I/we should consult with a qualified financial
or/and legal advisor.
I/We expressly acknowledge that TD Bank International S.A. shall not be obliged to open the account for any reason whatsoever, and
notably if the information provided is not complete, TD Bank International S.A. may request any other document that it deems
necessary.
I/We expressly acknowledge that TD Bank International S.A. will not authorise any transaction until formal confirmation of the
acceptance of the account opening by the Bank.
I/We confirm by returning this application form via post to TD Direct Investing International's postal address, that I/we have fully
understood, and accepted the contents of the following documents, which I/ we have read via the on-line application form. These
documents are available and downloadable on-line via the Investor Services section of the TD Direct Investing International website:
Application Brochure available at http://www.tddirectinvesting.lu/en-gb/~/media/td-bankinternational/forms/application_form.ashx
Commissions and rates available at http://www.tddirectinvesting.lu/en-gb/investment-products/fees-and-commissions/
Terms and Conditions available at http://www.tddirectinvesting.lu/en-gb/~/media/td-bankinternational/forms/terms_and_conditions.ashx
General Risk Warning Notice available at http://www.tddirectinvesting.lu/en-gb/~/media/td-bankinternational/forms/risk_warning_notice_general.ashx
Derivatives Risk Warning Notice available at http://www.tddirectinvesting.lu/en-gb/~/media/td-bankinternational/forms/risk_warning_notice_derivatives.ashx
Signature:
Page 2 of 2
Corporation
Grantor trust
Tax-exempt organization
Complex trust
Simple trust
Private foundation
Disregarded entity
Government
Partnership
Estate
International organization
4. Permanent residence address (street, apt or suite no.) DO NOT USE A P.O. BOX OR IN CARE OF ADDRESS
8. Account No.
EIN
The beneficial owner is a resident of __________________________ within the meaning of the income tax treaty between the United States and that country
PART 3: CERTIFICATION
Under the penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true,
correct, and complete. I further certify under penalties of perjury that:
1. I am the beneficial owner (or am authorized to sign for the beneficial owner) of all the income to which this form relates,
2. The beneficial owner is not a US person
3. The income to which this form relates is (a) not effectively connected with the conduct of a trade or business in the United States, (b) effectively connected but is
not subject to tax under an income tax treaty, or (c) the partners share of a partnerships effectively connected income, and
4. For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions
Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial owner or any
withholding agent that can disburse or make payments of the income of which I am the beneficial owner.
The Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required to establish
your status as a non-US person and, if applicable, obtain a reduced rate of withholding.
PART 4: SIGNATURE
Signature of beneficial owner
(or individual authorised to sign for beneficial owner)
Date
D D
M M
Y Y Y Y
An original completed form must be returned (faxed copies are NOT acceptable)
5.
6.
7.
8.
9a. Country should be completed without any abbreviations used. Applicants that would enter England, Scotland,
Wales or Northern Ireland should enter United Kingdom. Jersey, Guernsey and Isle of Man are not part of the
United Kingdom.
9b. Only tick this if question 6 above has been answered
Part IV - Signature
Please sign and date and if relevant enter in which capacity you are signing in. Capacity examples include; beneficial owner,
power of attorney, parent and guardian.
Important Information
Tax treaty rates do not override your actual tax liability in the country you reside but any tax withheld may be
deemed offsettable.
If you do not feel that the Form W-8BEN is appropriate, please visit www.irs.gov and review the available Form
W-8 series. Each form will have a corresponding instruction guide to help you understand the usage and
completion of the form.
CLIENT COPY
Please keep this copy
for your own records
APPLICATION SUMMARY
Application Details
Reference number:
9ST99MJR
Application type:
Individual
Existing account:
No
Contact name:
Mr Mohamed Mortada
Email address:
mdiaamortada@gmail.com
Phone number:
20 1224269451
Personal Details
Full name:
Civil status:
Separated / Divorced
Date of birth:
5 Mar 1961
Citizen of:
Egypt
Residency address:
Country of residence:
Egypt
Email address:
mdiaamortada@gmail.com
Business phone:
20 1224269451
Home phone:
20 226072149
Mobile phone:
20 1224269451
No
Hold mail:
No
Employer:
Eingineer
Address:
Bani Suef
Egypt
Company activity:
Chemical industry
Job title:
Engineering Manager
3 years, 8 months
CLIENT COPY
Please keep this copy
for your own records
APPLICATION SUMMARY
Financial Situation
Origin of funds:
Business Profits
Investment purpose:
Savings
25,000+
25,000 - 100,000
6 - 15
50000
Source Of Wealth:
Property appreciation
4-6
Wire
CBQ
Qatar
No
Investor Profile
Requested products:
Equities
Equity with Margin
Forex
Base currency:
Demo platform:
I will download and use the demo platform before it could go live.
Bank transfer (from a Bank established in a FATF country only) and a copy of your
passport or EU ID Card (for EU nationals only)