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{"0":{"lid":"1531306243545","ls":"10","loff":"","li_type":"em","li_name":"email","li_ph":"E-mail","li_req":"y","li_nm":"email"},"1":{"lid":"1531306540094","ls":"20","loff":"","li_type":"nm","li_name":"name","li_ph":"Имя ","li_nm":"name"},"2":{"lid":"1631002990773","ls":"30","loff":"","li_type":"ph","li_name":"phone","li_ph":"Номер телефона","li_req":"y","li_masktype":"a","li_maskcountry":"BY","li_nm":"phone"}}
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{"0":{"lid":"1613990856890","ls":"10","loff":"","li_type":"tx","li_text":"
1. Entity and Individual Information
"},"1":{"lid":"1613991119452","ls":"20","loff":"","li_type":"ws","li_rows":"1"},"2":{"lid":"1531306243545","ls":"30","loff":"","li_type":"in","li_name":"Full legal name of entity Entity or Firm or individual Individual:","li_title":"Full legal name of entity (“Entity” or “Firm”) or individual (“Individual”):*","li_nm":"Full legal name of entity Entity or Firm or individual Individual:"},"3":{"lid":"1613991106838","ls":"40","loff":"","li_type":"tx","li_text":"
If Entity, please check all that describe the nature of the Entity (Individuals, please select Not Applicable):*
"},"4":{"lid":"1612869949012","ls":"50","loff":"","li_type":"cb","li_name":"Bank Holding Company","li_label":"
Bank Holding Company
","li_nm":"Bank Holding Company"},"5":{"lid":"1612870101671","ls":"60","loff":"","li_type":"cb","li_name":"Commodity Pool","li_label":"
Commodity Pool
","li_nm":"Commodity Pool"},"6":{"lid":"1612870113751","ls":"70","loff":"","li_type":"cb","li_name":"Commodity Trading Advisor","li_label":"
Commodity Trading Advisor
","li_nm":"Commodity Trading Advisor"},"7":{"lid":"1612870116225","ls":"80","loff":"","li_type":"cb","li_name":"Hedge Fund","li_label":"
Hedge Fund
","li_nm":"Hedge Fund"},"8":{"lid":"1612870123403","ls":"90","loff":"","li_type":"cb","li_name":"Investment Bank","li_label":"
Investment Bank
","li_nm":"Investment Bank"},"9":{"lid":"1612870126435","ls":"100","loff":"","li_type":"cb","li_name":"Private Trust","li_label":"
Private Trust
","li_nm":"Private Trust"},"10":{"lid":"1612870130594","ls":"110","loff":"","li_type":"cb","li_name":"Proprietary Trading Firm","li_label":"
Proprietary Trading Firm
","li_nm":"Proprietary Trading Firm"},"11":{"lid":"1612870135239","ls":"120","loff":"","li_type":"cb","li_name":"Public Trust Company","li_label":"
Public Trust Company
","li_nm":"Public Trust Company"},"12":{"lid":"1612870147991","ls":"130","loff":"","li_type":"cb","li_name":"U.S. Registered Broker Dealer","li_label":"
U.S. Registered Broker Dealer
","li_nm":"U.S. Registered Broker Dealer"},"13":{"lid":"1612870150456","ls":"140","loff":"","li_type":"cb","li_name":"U.S. Registered Investment Advisor","li_label":"
U.S. Registered Investment Advisor
","li_nm":"U.S. Registered Investment Advisor"},"14":{"lid":"1612870156145","ls":"150","loff":"","li_type":"cb","li_name":"Not Applicable Individual","li_label":"
Not Applicable / Individual
","li_nm":"Not Applicable Individual"},"15":{"lid":"1612870162645","ls":"160","loff":"","li_type":"cb","li_name":"Other 1","li_label":"
Other
","li_nm":"Other 1"},"16":{"lid":"1612870447656","ls":"170","loff":"","li_type":"in","li_name":"If you selected Other in the question above please add more details:","li_title":"If you selected Other in the question above, please add more details:","li_nm":"If you selected Other in the question above please add more details:"},"17":{"lid":"1612870885678","ls":"180","loff":"","li_type":"tx","li_text":"
If Entity, please check the entity type, (Individuals, please select Not Applicable):*
"},"18":{"lid":"1613991313838","ls":"190","loff":"","li_type":"cb","li_name":"Publicly Traded Company","li_label":"
Publicly Traded Company
","li_nm":"Publicly Traded Company"},"19":{"lid":"1612870922192","ls":"200","loff":"","li_type":"cb","li_name":"Limited Liability Company","li_label":"
Limited Liability Company
","li_nm":"Limited Liability Company"},"20":{"lid":"1612870928407","ls":"210","loff":"","li_type":"cb","li_name":"Partnership","li_label":"
Partnership
","li_nm":"Partnership"},"21":{"lid":"1612870931463","ls":"220","loff":"","li_type":"cb","li_name":"Trust","li_label":"
Trust
","li_nm":"Trust"},"22":{"lid":"1612870938170","ls":"230","loff":"","li_type":"cb","li_name":"Not Applicable Individual","li_label":"
Not Applicable / Individual
","li_nm":"Not Applicable Individual_2"},"23":{"lid":"1612870944250","ls":"240","loff":"","li_type":"cb","li_name":"Other 2","li_label":"
Other
","li_nm":"Other 2"},"24":{"lid":"1612875255723","ls":"250","loff":"","li_type":"in","li_name":"If you selected Other in the question above please describe below:","li_title":"If you selected Other in the question above, please describe below:","li_nm":"If you selected Other in the question above please describe below:"},"25":{"lid":"1612875595978","ls":"260","loff":"","li_type":"cb","li_name":"By checking this box, the signing party agrees to attach Entity formation documents, if applicable, or a government-issued certified document showing the existence of the Entity or identification of the Individual. You understand that this will be submitted concurrently with this form below.*","li_label":"
By checking this box, the signing party agrees to attach Entity formation documents, if applicable, or a government-issued certified document showing the existence of the Entity or identification of the Individual. You understand that this will be submitted concurrently with this form below.*
","li_nm":"By checking this box, the signing party agrees to attach Entity formation documents, if applicable, or a government-issued certified document showing the existence of the Entity or identification of the Individual. You understand that this will be submitted concurrently with this form below.*"},"26":{"lid":"1613141775464","ls":"270","loff":"","li_type":"uc","li_name":"file 1","li_title":"Entity Formation Documents","li_subtitle":"Required if Entity; you can select multiple docs in dialog for upload","li_nm":"file 1"},"27":{"lid":"1613141761839","ls":"280","loff":"","li_type":"ws","li_rows":"3"},"28":{"lid":"1613991426457","ls":"290","loff":"","li_type":"tx","li_text":"
2. Contact Information
"},"29":{"lid":"1613991510701","ls":"300","loff":"","li_type":"ws","li_rows":"1"},"30":{"lid":"1613991436902","ls":"310","loff":"","li_type":"tx","li_text":"
Address of principal place of business, registered address, or other physical address:
"},"31":{"lid":"1612874454631","ls":"320","loff":"","li_type":"in","li_name":"Street Address","li_title":"Street Address*","li_req":"y","li_nm":"Street Address"},"32":{"lid":"1612874569246","ls":"330","loff":"","li_type":"in","li_name":"City","li_title":"City*","li_req":"y","li_nm":"City"},"33":{"lid":"1612874584438","ls":"340","loff":"","li_type":"in","li_name":" StateProvinceRegion","li_title":" State/Province/Region*","li_req":"y","li_nm":" StateProvinceRegion"},"34":{"lid":"1612874599586","ls":"350","loff":"","li_type":"in","li_name":"Country","li_title":"Country*","li_req":"y","li_nm":"Country"},"35":{"lid":"1612874611666","ls":"360","loff":"","li_type":"in","li_name":" Postal Code Zip Code","li_title":" Postal Code / Zip Code*","li_rule":"number","li_req":"y","li_nm":" Postal Code Zip Code"},"36":{"lid":"1612874619028","ls":"370","loff":"","li_type":"in","li_name":"Email","li_title":"Email*","li_rule":"email","li_req":"y","li_nm":"Email"},"37":{"lid":"1612874650373","ls":"380","loff":"","li_type":"in","li_name":" Phone Number","li_title":" Phone Number","li_rule":"phone","li_nm":" Phone Number"},"38":{"lid":"1612874675112","ls":"390","loff":"","li_type":"in","li_name":"Website","li_title":"Website","li_nm":"Website"},"39":{"lid":"1612874825867","ls":"400","loff":"","li_type":"ws","li_rows":"3"},"40":{"lid":"1613991653634","ls":"410","loff":"","li_type":"tx","li_text":"
3. Relevant Registrations and Classifications
"},"41":{"lid":"1613991695579","ls":"420","loff":"","li_type":"ws","li_rows":"1"},"42":{"lid":"1613991675336","ls":"430","loff":"","li_type":"tx","li_text":"
Please check all descriptions that apply to the Entity or Individual:*
"},"43":{"lid":"1612874973094","ls":"440","loff":"","li_type":"cb","li_name":"U.S. Public Company","li_label":"
U.S. Public Company
","li_nm":"U.S. Public Company"},"44":{"lid":"1612875009331","ls":"450","loff":"","li_type":"cb","li_name":"U.S. FINRA Member Broker Dealer","li_label":"
U.S. FINRA Member Broker Dealer
","li_nm":"U.S. FINRA Member Broker Dealer"},"45":{"lid":"1612875015709","ls":"460","loff":"","li_type":"cb","li_name":"National Futures Association NFA Member","li_label":"
National Futures Association (NFA) Member
","li_nm":"National Futures Association NFA Member"},"46":{"lid":"1612875047979","ls":"470","loff":"","li_type":"cb","li_name":"U.S. Registered Investment Advisor","li_label":"
U.S. Registered Investment Advisor
","li_nm":"U.S. Registered Investment Advisor_2"},"47":{"lid":"1612875054383","ls":"480","loff":"","li_type":"cb","li_name":"Member of the Federal Deposit Insurance Corporation FDIC","li_label":"
Member of the Federal Deposit Insurance Corporation (FDIC)
","li_nm":"Member of the Federal Deposit Insurance Corporation FDIC"},"48":{"lid":"1612875060733","ls":"490","loff":"","li_type":"cb","li_name":"Money Services Business MSB","li_label":"
Money Services Business (MSB)
","li_nm":"Money Services Business MSB"},"49":{"lid":"1612875065148","ls":"500","loff":"","li_type":"cb","li_name":"None of the Above","li_label":"
None of the Above
","li_nm":"None of the Above"},"50":{"lid":"1612875240579","ls":"510","loff":"","li_type":"in","li_name":" If applicable please provide your CRD andor NFA ID:","li_title":" If applicable, please provide your CRD# and/or NFA ID#:","li_nm":" If applicable please provide your CRD andor NFA ID:"},"51":{"lid":"1612875334513","ls":"520","loff":"","li_type":"in","li_name":" Please detail in which states the Entity or Individual is registered as an MSB:","li_title":" Please detail in which states the Entity or Individual is registered as an MSB:","li_nm":" Please detail in which states the Entity or Individual is registered as an MSB:"},"52":{"lid":"1612875491104","ls":"530","loff":"","li_type":"tx","li_text":"
Has the Individual or Entity ever been sanctioned by any Self-Regulatory Organization, National Competent Authority, or other financial regulator?*
"},"53":{"lid":"1613992342993","ls":"540","loff":"","li_type":"cb","li_name":"YES1","li_label":"
YES
","li_nm":"YES1"},"54":{"lid":"1612875510187","ls":"550","loff":"","li_type":"cb","li_name":"NO1","li_label":"
NO
","li_nm":"NO1"},"55":{"lid":"1612875630221","ls":"560","loff":"","li_type":"uc","li_title":"If yes, please provide an attached explanation for each sanction issued against the Entity or Individual.","li_subtitle":"You can select multiple docs in dialog for upload","li_nm":"If yes please provide an attached explanation for each sanction issued against the Entity or Individual."},"56":{"lid":"1613464112963","ls":"570","loff":"","li_type":"tx","li_text":"
If Entity, is the Entity a US company?*
"},"57":{"lid":"1613992359267","ls":"580","loff":"","li_type":"cb","li_name":"YES2","li_label":"
YES
","li_nm":"YES2"},"58":{"lid":"1613464105997","ls":"590","loff":"","li_type":"cb","li_name":"NO2","li_label":"
NO
","li_nm":"NO2"},"59":{"lid":"1613464261140","ls":"600","loff":"","li_type":"in","li_name":"If yes please provide the Employer Identification Number EIN assigned to this Entity:","li_title":"If yes, please provide the Employer Identification Number (“EIN”) assigned to this Entity:","li_nm":"If yes please provide the Employer Identification Number EIN assigned to this Entity:"},"60":{"lid":"1613464358408","ls":"610","loff":"","li_type":"cb","li_name":"If no by checking this box the signing party agrees to submit a government issued document such as a business license or foreign tax registration document concurrently with this form.","li_label":"
If no, by checking this box the signing party agrees to submit a government issued document such as a business license or foreign tax registration document concurrently with this form.
","li_nm":"If no by checking this box the signing party agrees to submit a government issued document such as a business license or foreign tax registration document concurrently with this form."},"61":{"lid":"1613464407962","ls":"620","loff":"","li_type":"uc","li_name":"file","li_title":"Foreign Tax Document or Business License (if applicable)","li_subtitle":"You can select multiple docs in dialog for upload","li_nm":"file"},"62":{"lid":"1613464450938","ls":"630","loff":"","li_type":"tx","li_text":"
Is the Entity or Individual an Eligible Contract Participant under 7 U.S. Code § 1a (18)?*
"},"63":{"lid":"1613991782720","ls":"640","loff":"","li_type":"cb","li_name":"YES3","li_label":"
YES
","li_nm":"YES3"},"64":{"lid":"1613464473204","ls":"650","loff":"","li_type":"cb","li_name":"NO3","li_label":"
NO
","li_nm":"NO3"},"65":{"lid":"1613464545484","ls":"660","loff":"","li_type":"tx","li_text":"
Please check all government regulatory agencies with jurisdiction over the Entity or Individuals activities:*
"},"66":{"lid":"1613991807948","ls":"670","loff":"","li_type":"cb","li_name":"Securities and Exchange Commission SEC","li_label":"
Securities and Exchange Commission (SEC)
","li_nm":"Securities and Exchange Commission SEC"},"67":{"lid":"1613464565947","ls":"680","loff":"","li_type":"cb","li_name":"Commodity Futures Trading Commission CFTC","li_label":"
Commodity Futures Trading Commission (CFTC)
","li_nm":"Commodity Futures Trading Commission CFTC"},"68":{"lid":"1613464571987","ls":"690","loff":"","li_type":"cb","li_name":"State Regulatory Agency","li_label":"
State Regulatory Agency
","li_nm":"State Regulatory Agency"},"69":{"lid":"1613464584780","ls":"700","loff":"","li_type":"cb","li_name":"Foreign Financial National Competent Authority I.e. FCA BaFIN et al.","li_label":"
Foreign Financial National Competent Authority (I.e. FCA, BaFIN, et al.)
","li_nm":"Foreign Financial National Competent Authority I.e. FCA BaFIN et al."},"70":{"lid":"1613464590001","ls":"710","loff":"","li_type":"cb","li_name":"None","li_label":"
None
","li_nm":"None"},"71":{"lid":"1613464593830","ls":"720","loff":"","li_type":"cb","li_name":"Other","li_label":"
Other
","li_nm":"Other"},"72":{"lid":"1613464796086","ls":"730","loff":"","li_type":"in","li_name":" If you selected State Regulatory Agency please describe:","li_title":" If you selected State Regulatory Agency, please describe:","li_nm":" If you selected State Regulatory Agency please describe:"},"73":{"lid":"1613470855018","ls":"740","loff":"","li_type":"in","li_name":" If you selected Foreign Financial National Competent Authority I.e. FCA BaFIN et al. please include the Foreign Regulator and the Foreign Identifying Number here:","li_title":" If you selected Foreign Financial National Competent Authority (I.e. FCA, BaFIN, et al.), please include the Foreign Regulator and the Foreign Identifying Number here:","li_nm":" If you selected Foreign Financial National Competent Authority I.e. FCA BaFIN et al. please include the Foreign Regulator and the Foreign Identifying Number here:"},"74":{"lid":"1613470861734","ls":"750","loff":"","li_type":"in","li_name":"If you selected Other please list any other government regulators with jurisdiction over the Entity or Individual:","li_title":"If you selected Other, please list any other government regulators with jurisdiction over the Entity or Individual:","li_nm":"If you selected Other please list any other government regulators with jurisdiction over the Entity or Individual:"},"75":{"lid":"1613471000614","ls":"760","loff":"","li_type":"tx","li_text":"
Please describe the origin of funds to be used for this business:*
"},"76":{"lid":"1613991846037","ls":"770","loff":"","li_type":"cb","li_name":"Corporate Investment Account","li_label":"
Corporate Investment Account
","li_nm":"Corporate Investment Account"},"77":{"lid":"1613471020335","ls":"780","loff":"","li_type":"cb","li_name":"Savings","li_label":"
Savings
","li_nm":"Savings"},"78":{"lid":"1613471032173","ls":"790","loff":"","li_type":"cb","li_name":"Trust","li_label":"
Trust
","li_nm":"Trust_2"},"79":{"lid":"1613471040415","ls":"800","loff":"","li_type":"cb","li_name":"Investment Income","li_label":"
Investment Income
","li_nm":"Investment Income"},"80":{"lid":"1613471050947","ls":"810","loff":"","li_type":"cb","li_name":"Retirement","li_label":"
Retirement
","li_nm":"Retirement"},"81":{"lid":"1613471056683","ls":"820","loff":"","li_type":"cb","li_name":"Other","li_label":"
Other
","li_nm":"Other_2"},"82":{"lid":"1613471083109","ls":"830","loff":"","li_type":"in","li_name":"If you selected Other please provide details below:","li_title":"If you selected Other, please provide details below:","li_nm":"If you selected Other please provide details below:"},"83":{"lid":"1613471093369","ls":"840","loff":"","li_type":"tx","li_text":"
Please confirm that any fiat or virtual currency transfer instructions will reflect account(s) or wallet(s) which are owned and controlled by the Individual or Entity noted in Question 1:*
"},"84":{"lid":"1613991885210","ls":"850","loff":"","li_type":"cb","li_name":"YES4","li_label":"
YES
","li_nm":"YES4"},"85":{"lid":"1613471124930","ls":"860","loff":"","li_type":"cb","li_name":"NO4","li_label":"
NO
","li_nm":"NO4"},"86":{"lid":"1613471186633","ls":"870","loff":"","li_type":"in","li_name":"Please describe the nature of the Individual or Entitys trading strategy:","li_title":"Please describe the nature of the Individual or Entity’s trading strategy:*","li_nm":"Please describe the nature of the Individual or Entitys trading strategy:"},"87":{"lid":"1613471205375","ls":"880","loff":"","li_type":"ws","li_rows":"3"},"88":{"lid":"1613991925606","ls":"890","loff":"","li_type":"tx","li_text":"
4. Beneficial Owner Information
"},"89":{"lid":"1613992418643","ls":"900","loff":"","li_type":"ws","li_rows":"1"},"90":{"lid":"1613471702129","ls":"910","loff":"","li_type":"in","li_name":" Provide Individuals own name if onboarding as an Individual.","li_title":"Please provide the name of a beneficial owner with significant responsibility for managing the legal Entity (e.g., a Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, Managing Member, General Partner, President, Vice President, or Treasurer):*","li_subtitle":" Provide Individuals own name if onboarding as an Individual.","li_nm":" Provide Individuals own name if onboarding as an Individual."},"91":{"lid":"1613471773770","ls":"920","loff":"","li_type":"in","li_name":"If onboarding as an Individual or if no beneficial owners meet this requirement say None.","li_title":"If Entity, provide the names of each beneficial owner who owns, directly or indirectly, 25 percent or more of the equity interests of the legal Entity (e.g., each natural person that owns 25 percent or more of the shares of a corporation):*","li_subtitle":"If onboarding as an Individual or if no beneficial owners meet this requirement, say None.","li_nm":"If onboarding as an Individual or if no beneficial owners meet this requirement say None."},"92":{"lid":"1613471793644","ls":"930","loff":"","li_type":"in","li_name":"Describe if so otherwise say No.","li_title":" Are any of the beneficial owners a Politically Exposed Person (PEP) as defined by the Financial Action Task Force (FATF) standard?*","li_subtitle":"Describe if so, otherwise say No.","li_nm":"Describe if so otherwise say No."},"93":{"lid":"1613471805499","ls":"940","loff":"","li_type":"uc","li_name":"An ID is not an accepted proof of address document you can select multiple docs in dialog for upload","li_title":"For each beneficial owner, please provide a valid government ID and recent proof of address.*","li_subtitle":"An ID is not an accepted proof of address document; you can select multiple docs in dialog for upload","li_nm":"An ID is not an accepted proof of address document you can select multiple docs in dialog for upload"}}