Regulated by the FSA Securities &

Exchange Commission (License# 247/14)

Economic Profile Questionnaire

Please send the completed form support@star-clicks.com
Please fill in all your information clearly and accurately in BLOCK CAPITAL letters

ACCOUNT HOLDER
Personal Information:
First Name SAEFUL
Last Name TAMAN
Title (Mr/Mrs/Miss/other) Mr
Birth Date 14 - 09 - 1991
Nationality ASIA
US FATCA Reportable * YES / NO
Residential Address:
Country INDONESIA
City BANDUNG
Zip 40395
Address KP BABAKAN ASIH
Telephone Number +6289655381124
□ Platform testing □ Full time worker □ Part time worker □ Working short
Online Working Appetite term (1y - 5y) □ Working long term (5y+)

Anticipated Annual Investment

□ Less than €1000 □ €1,001 -€10,000 □ €10,001 - €50,000 □ €50,001+
Amount
□ 0 - 30,000 □ 30,001 - 100,000 □ 100,001 - 300,000 □ 300,001 - 500,000 □
Total Annual Income (€)
500,001 +
□ 0 - 30,000 □ 30,001 - 100,000 □ 100,001 - 300,000 □ 300,001 - 500,000 □
Estimated Net Worth (€)
500,001 +
□ Salary □ Savings □ Pension □ Rent Income □ Financial Market Earnings □
Parent/Family □ Dividends □ Other
(If other please specify) …………………………………………………………………………………
□ Employed □ Self-employed □ Unemployed □ Student □ Retired □ Full time
Employment Status
trader
□ Below High School □ High School □ Bachelor Degree □ Post Graduate
Education Level
Degree □ Professional Qualification
□ Equities □ Bonds □ Futures & other Derivatives □ Forex □ CFD’s □
Knowledge and experience
Binary Options □ None
For how long have you been working
□ Never □ Less than a year □ 1-3 years □ 3 years +
online?
Have you attended any courses
YES / NO

Do you have relevant work experience

that helps you understand the
YES / NO
products and services including the
risks
*A US reportable person is classified as anyone who holds one of the following: US Citizenship, Residency, Tax Identification Number or Mailing,
Residential Address, Telephone number, as well as anyone who has instructions to fund an account maintained in the US
DATE: 19 - 06 - 2024 SIGNATURE:

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