This form must be typed. Do not send hand written form

Account Closure Further Information Request

This form must be typed. Do not send hand written form.

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Usmonov

Feruz

First name Last name

[e-mail]

Date of birth Email

AA 8901829

[phone]

Telephone number Passport/ID number

Postal Address



Why have you opened an investment account with Unique Finance at the first place?

For Investment

__________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________

Why you have decided to close your account?

___For Investment riend____________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________

Who introduced you to the system? ____ Friend__________________________________________

What is your total annual income (before tax)? ____________________________________________________
What is your day job? ______ Sales Manages__________________________________
What was the source of the funds you have used to open Unique Finance Account? _____ Save money __________________
__________________________________________________________________________________________________________________________________________________________________________________________________

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Expert ID Registered Date


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Total Deposit (USD) Total Income (USD) Balance (USD)

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To another Expert ID To your own Bank Account
^{Account Number} Account Name IBAN/SWIFT/SORT CODE

Bank Name & Address Other Details (if applicable)


I give my consent for closing my account mentioned above with Unique Finance. I hereby release, indemnify and hold harmless Unique Finance, Global Portfolio Management, the organizers, sponsors, staff, experts, advisors and supervisors of all its activities relating to Unique Finance and Global Portfolio Management from any and all liability in connection with my account with the above details. I understand that I will surrender all my rights if any in relation to this account and Unique Finance, Global Portfolio Management, the organizers, sponsors, staff, experts, advisors and supervisors of all its activities relating to Unique Finance and Global Portfolio Management have no further responsibilities and obligations towards my account or me. I hereby surrender all my right, title and interest in Unique Finance, Global Portfolio Management, the organizers, sponsors, staff, experts, advisors and supervisors of all its activities relating to Unique Finance and Global Portfolio Management.

Signed & Dated by the Account Holder

25.11.2021

Document checklist:

√ Fill this form completely & put your initials on the bottom of each and every page.

√ Sign and Date the form.

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√ Attach a recent passport size photograph of account holder.

√ Attach a notarized & certified copy of passport or ID card.

Send documents above to the following address with recorded postal service and keep the receipt for your records.

Account Closure – Request for more information – Global Portfolio Management – C9918-12



For official use only