Account Reference 1
Account Name
(for internal use only)
Please complete this section indicating how you wish to have the account registered/recorded for future reference
Account Name
2
Applicant Details
First Applicant Title
Forename(s)
Surname
Forename(s)
Surname
Trust Name Company Name Second Applicant Title
3
Investment Details
Investment Amount
No. of transactions per year
Reporting Currency
Average transaction value
Portfolios may choose to have distributions and income
4
Paid out
Please indicate number of transactions Please indicate average transaction value
or
Retained for investment
Source of Funds
The funds to be invested with Capital Treasury Services Limited are to originate from: (please state bank or building society name and address)
Source of Funds
5
Source of Wealth
Please indicate the underlying source of your wealth, e.g. if your wealth is derived from salary/bonus please give an indication of your annualised salary I/We confirm that the source of my/our wealth represented by the funds to be held in this account derive from:
Description
Amount / Value
Details
Business Profits Life Savings Salary/Bonus Business Share/Sale House/Property Sale Pension Settlement Inheritance Other
6
On-line Access - Registration Process
Would you like online access to your account?
Yes
No
If ‘Yes’ then please refer to the notes below.
Visit www.capital-cts.com and click on Online Services in the top menu bar, the page will redirect you to a secure site where you will need to ‘Click here’ to register where you will need to complete and submit the form. You will be sent a confirmation email to the email address you specified - just follow the instructions on the email which provides a link back to the website (please note this link is only valid for 24 hours) which will redirect you to the website, where you will need to confirm your registration details and allow application for services. NOTE: You will be asked for a password during the registration process - an access password should be a memorable name or word which is typically 7 or 8 characters long.
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© Capital Treasury Services Limited 2011
7
Investment Details * Foreign Exchange:
Portfolio Base Currency Investment Minimums: The investment vehicles listed have a minimum investment of: £10,000, $20,000 or €20,000 Apart from the Capital Liquidity Account which has a minimum of: £50,000, $100,000 or €100,000 Please indicate below your investment amount - space has been provided if you are wishing to invest in multiple currencies.
Capital Liquidity Account
%
Capital Platinum Fixed Term Bond
%
Discretionary Treasury Management
%
Foreign Exchange Services *
%
Investment 1
Gold Bullion & Precious Metals
%
Investment 2
Money Market & Cash Investments
%
Investment 3
Structured Products
%
8
Please indicate below the proposed currencies you wish to trade using our Foreign Exchange Services
Please indicate the Treasury Service you require by ticking the relevant box and answer the relevant questions where possible - for help or further information please contact Capital Treasury Services on +44 (0) 1624 654290
Treasury Services
Capital Treasury Services Limited is not the product provider but acts as an Introducer and Payment Service Provider for this third party service on behalf of Conister Bank Limited and Tuxedo Money Solutions Limited
Pre-Paid Debit Card Services Number of Cards
Sterling
US Dollars
Euro
Other
Number of Transactions per month
Sterling
US Dollars
Euro
Other
Volume of Turnover per day/week
Sterling
US Dollars
Euro
Other
Expected Total Card Volumes
Year 1
Year 2
Year 3
Indicative Load Value Nature of Card Business
Any sums received do not constitute a deposit as defined in Regulated Activities Order 2011, as amended and are not covered by any compensation scheme.
International & Domestic Payment Services Number of Payments per day/week
Sterling
US Dollars
Euro
Other
Sterling
US Dollars
Euro
Other
Size of Payments Nature of Payments
Volume of Turnover per day/week
9
Intermediary Details
This section should only be completed by Intermediaries. Please enter the appropriate details here and avoid supplying information on separate sheets.
Intermediary Name Intermediary Stamp/Details:
Registered Address Postcode I / we confirm that I / we am / are registered with / regulated by the following body to conduct investment business:
Firm Ref No I am/am not registered for VAT: Please tick the relevant commission structure:
X
A
X
B
C
X
D
Other:
.
If ‘Other’ is selected please specify the terms required on this application form; all terms must be agreed with Capital Treasury Services Limited in advance.
Contact Name Telephone Number E-mail Address
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© Capital Treasury Services Limited 2011
10 Declaration & Signature
You must sign and date the form below
I/We understand that the information I/we provide on this application form, and any additional information supplied, will be processed in accordance with Capital Treasury Services Limited’s Data Protection statement contained in the Terms of Business referred to below, and for the Pre-Paid Debit Card Service where your data will be passed on to the Product Provider notice should be made of the Data Protection statement contained within Conister Bank Limited’s and Tuxedo Money Solutions Limited’s Terms & Conditions. By signing below, I/we confirm that I/we have received the relevant documentation and advice relating to this Investment and/or Treasury Service, and Terms which I/we accept. I/We declare that: I/We am/are 18 years of age or over. I/We agree that the information contained within this application form is true and accurate. I/We have received, read and understood the Capital Treasury Services Limited product brochures (please indicate where appropriate): CTS - Bullion & Precious Metals Brochure - V1.01-08.10 and/or CTS - CLA Brochure - V1.01-01.12 and/or CTS - CLMA Brochure - V1.01-08.10 and/or CTS - Foreign Exchange Brochure - V1.01-08.10 and/or CTS - Bridge: International Payment & Cash Management Brochure - V1.01-01.12 and/or CTS - Money Market Investments Brochure - V1.01-08.10 and/or CTS - Platinum Bond Brochure - V1.01-08.10 and/or CTS - Pre-Paid Debit Card Services Brochure - V1.01-08.10 and/or CTS - Treasury Management Brochure - V1.01-08.10 I/We have received, read, understood and agree to be bound by the following document as given to me: CTS - Retail Terms of Business V1.01-01.12 or CTS - Terms of Business V1.01-01.12 or CIL - Capital Liquidity Account Terms of Business V1.01-08.10 In the case of the Capital Treasury Services Limited Pre-Paid Debit Card Services, I/we am/are aware that this is a third party service with Conister Bank Limited and Tuxedo Money Solutions Limited and agree with the relevant Terms & Conditions as supplied by them. If you have not received all of the aforementioned documentation relating to your Capital Treasury Services Investment and/or Service, or do not fully understand the Investments and/or Treasury Service offerings then please contact your Financial Adviser or us immediately. Capital Treasury Services Limited may use your personal information to tell you about products and services which we believe may be of interest to you. If you do not wish your personal information to be used in this way, please put an X in this box.
Signing Authority (Joint Accounts)
Please indicate who Delete as appropriate - Signing Together / Signing Alone _______________________________
Signatures of ALL Applicants (YOU MUST SIGN HERE - Please ensure all relevant sections are completed as per the instructions on this form)
First Signature
PLEASE SIGN HERE Date
D D
Print Name
M M
2 0 Y Y
M M
2 0 Y Y
Second Signature
PLEASE SIGN HERE Date
D D
Print Name
Internal Use Only D D
M M
Acknowledged By:
Application Processed:
2 0 Y Y
D D
M M
Acknowledged By:
2 0 Y Y
Client Notification Sent:
D D
M M
2 0 Y Y
Acknowledged By:
Winner
CTS - Treasury Management PAF4 - V1.01-01.12
Received Date: