Individual Customer Questionnaire

Are you a customer of our Bank?*

Yes

Markets of interest for you*

Corporate Securities Market of the Moscow Inter-Bank Currency Exchange (CSM MICEX)

International stock markets (OTC market)

Surname*

First name*

Second name

Date of birth*

(DD.MM.YYYY)

Place of birth*

Citizenship*

Gender*

Male

Female

Individual Taxpayer Number (INN)

Residence/registration address (country, region, republic, area, district, locality, house number, building number, apartment number)*

Actual address (if different from registered address)

Place of employment*

Address of employment*

Position*

Russian resident*

Yes

Phone*

Phone 2

E-mail*

Certificate type (passport)*

Series*

Number*

Issue date*

(DD.MM.YYYY)

Issued by, division code*

* - Required fields