Investor's email* Type of Investor*Individuals or Joint AccountEntityInvestment Trading ProgramPlease select the programs you're planning to invest in. RCube Commodity Spread Program Aquanthus Premia Program Date de mise à jour* Date Format: DD slash MM slash YYYY INDIVIDUAL AND JOINT ACCOUNTSRCube Asset Management SAS is required to obtain certain information about its clients. Please assist us by providing the information requested below. This form is for Individual and Joint Accounts. For Corporate or Entity clients, please use the applicable form provided within this document.First Client* MrMrsMissMsDrProf.Rev. Prefix First Last Please printResidence Address* Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home Phone NumberCell Phone NumberGovernment Issued ID NumberPassport or IDSocial Security NumberDate of Birth* DD MM YYYY Day DateMarial Status*Number of DependentsPrincipal Occupation or Business*Current Estimated Annual Income*in USDCurrent Estimated Net Worth*in USDAvailable Working Capitalin USDNumber of Years of Investment ExperienceNumber of Years of Futures Trading ExperiencePassportPlease upload a digital version of the ID pages of y a valid Passport. Drop files here or Accepted file types: jpg, png, pdf. QEP Questionnaire (Individuals)In order to be considered a Qualified Eligible Person (“QEP”), as defined in CFTC Regulation 4.7, you must meet both a requirement in Section 1 and a requirement in Section 2, or you may meet one of the requirements in Section 3.Section 1Please check all that apply A natural person whose individual net worth, or joint net worth with that person’s spouse, exceeds $1,000,000 A natural person who had an individual income in excess of $200,000 in each of the two most recent years or joint income with that person’s spouse in excess of $300,000 in each of those years and has a reasonable expectation of reaching the same income level in the current year. Section 2 Owns securities (including pool participations) of issuers not affiliated with him and other investments with an aggregate market value of at least $2,000,000. Has had on deposit with an FCM at least $200,000 in exchange-specified initial margin and option premiums for commodity interest transactions, together with the required minimum security deposit for retail forex transactions, in the six months prior to the investment. Has a combination of the two requirements above (a), expressed as a percentage of the minimum amount required thereunder, and the amount of futures margin and option premiums includible under (b), expressed as a percentage of the minimum amount required thereunder, equals at least one hundred percent. For Example: $1,000,000 in securities and other property as 50% of (a) and $100,000 in exchange specified initial margin and option premiums as 50% of (b). Section 3 A natural person who is not a resident of the United States. For these purposes, “United States” means the United States, its states, territories or possessions, or an enclave of the United States government, its agencies or instrumentalities. Qualified Eligible Person meeting other criteria pursuant to CFTC Regulation 4.7. List other qualifying criteria : Other qualifying criteriaClient certifies that he or she is a Qualified Eligible Person, as defined in CFTC Regulation 4.7, and represents that all information furnished above is accurate. UntitledblablaCAPTCHAEmailThis field is for validation purposes and should be left unchanged.