Phone Mail

Declaration Form

License no. 296/16 Highest Security standards


Dear Customer

FATCA Reportable Persons

Taking into consideration the newly proposed U.S. Regulations all Foreign Financial Institutions (“FFIs”) will need to comply with the Foreign Account Tax Compliance Act (“FATCA”). In accordance to FATCA we as an FFI are required to disclose information in relation to our US reportable persons.

All US reportable persons will need to notify the FFI accordingly, so as to be able to comply with the FATCA regulations.

Definition of US reportable person:

  • A U.S. citizen (including dual citizen)
  • A U.S. resident alien for tax purposes
  • A domestic partnership
  • A domestic corporation
  • Any estate other than a foreign estate

Any trust if:

  • A court within the United States is able to exercise primary supervision over the administration of the trust, and
  • One or more United States persons have the authority to control all substantial decisions of the trust
  • Any other person that is not a foreign person.


Please go through the declaration below to provide your agreement or not:

  • I am not a U.S. citizen (including dual citizen) or resident
  • My birthplace is not in the U.S.
  • I do not have a current U.S. mailing or residence address (including a U.S. post office box or U.S. “in-care-of” address)
  • I do not have a current U.S. telephone number
  • I do not have standing instructions to transfer funds to an account maintained in the United States
  • I do not have currently effective power of attorney or signatory authority granted to a person with a U.S. address
  • I do not have an “in-care-of” or “hold mail” address that is the sole address for the Account Holder.  The Investor needs to note that in the case of a Pre-existing Individual Account that is a Lower Value Account, an “in-care-of” address outside the United States is not to be treated as U.S. indicia.
  • I do not possess a U.S. TIN (hereafter “Tax Identification Number”).

In case you are in agreement with the above declaration, thank you for your time and assistance in this process, you are now one step closer to proceeding in trading with our Company.

As per your declaration, you are considered as a U.S. Reportable person. The Company is obligated to
report specific information to the U.S. IRS in relation to our U.S. Reportable persons.

In this respect, we would like to notify you that the following information is to be reported:


  1. Name, address and U.S. TIN (hereafter “Tax Identification Number”), takes into account
    U.S. Reportable person and entities with U.S. substantial ownership above 10%;
  2. Account Number;
  3. Name and identifying number of the Reporting Cypriot Financial Institution;
  4. Account balance or value;
  5. All information in case of a Custodian Account;
  6. All information in case of a Depository Account;
  7. Any other account, the total gross amount paid or credited to the Account Holder with respect to the account during the calendar year or the other appropriate reporting period.

Please provide us with the information depicted in number 1 above, so as to be able to construct the client
profile that is to be reported to the U.S. IRS department.

Thank you for your cooperation in this matter.

[ back to top ]

To keep trading with OptionsClick *“Agree” Please

* I accept all LTL’s (Leadtrade ) policies and terms and conditions