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Application Form



Firstname:
Lastname:
Address:
City:
State
Zip code:
Country:
Telephone:
Username:
  • Select your own user name, consisting of anything between 7 and 50 alpha and/or numerical characters
  • It may contain alpha and/or numeric characters
  • The field is not case sensitive
Password:
  • Select your own password . The password may not contain your username
  • The field is case sensitive
    (that means a letter "R" is different to a letter "r")
  • Remember this password as you will need it to log into the website in future
Confirm password:
Pin: Enter 4 to 5 character pin
Confirm pin:
Email address:
Photo ID :
Occupation

Account Type:
Currency Type: