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CRS Entity Self-Certification Form

Read these instructions before completing the form

Complete Parts 1 – 3 below

PART 1 - ENTITY ACCOUNT HOLDER – IDENTIFICATION

Information provided will apply to any and all accounts you hold under FXCM Group, even if not specifically listed below.

PART 2 - ENTITY TYPE

Provide the Account Holder's Status by ticking one of the following boxes:

Financial Institution

Active NFE ( Non-Financial Entity )

PART 3 - COUNTRY OF RESIDENCE FOR TAX PURPOSES AND RELATED TAXPAYER IDENTIFICATION NUMBER OR FUNCTIONAL EQUIVALENT (“TIN”)

Please provide the Company tax residency and the Company TIN for each tax residency selected.

If the Company is a tax resident in more than three countries please submit a separate form listing each additional country.




PART 4 - DECLARATIONS AND SIGNATURE

By submitting this form, I declare that all statements made in this declaration are, to the best of my knowledge and belief, correct and complete.

I undertake to advise FXCM within 30 days of any change in circumstances which affects the tax residency status of the individual identified in Part 1 of this form or causes the information contained herein to become incorrect, and to provide FXCM with a suitably updated self-certification and Declaration within 90 days of such change in circumstances.

Please indicate the capacity in which you are signing the form (for example ‘Authorised Officer’). If signing under a power of attorney please also email a certified copy of the power of attorney to admin@fxcm.com.