APPLICATION FORM

Join the Force Behind Global Rare Earth Leadership

First name

Last name

Email

Company name

Position

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

Birthday

Month

Day

Year

Source of Trading Account Funds:

This Account Will Trade:

Equities

Funds

Currencies

Account Management:

Fully Managed

Broker Assisted

Self Managed

Currencies

Transferring from an existing broker to Gold Crest Metals?:

Yes

No

Current Employment Status:

Employed (full/part time)

Self-Employed

Retired

Other

Employment Industry/ Sector:

Annual Income (USD):

Less than $25,000

$25,001 - $99,999

$100,000 - $499,999

$500,000 +

Your Trading Experience:

Novice

Semi-Experienced

Experienced

Advanced

Primary Account Holder:

Secondary Account Holder:

Use the option below to upload a copy of your Passport or a Valid ID:

Use the option below to upload a a scan of a recent utility bill (dated within the last six months)

By checking this box and by typing my/our signature(s) below and forwarding this application form to Gold Crest Metals via the Internet, I/we acknowledge, understand and agree to the Disclosure Agreement as set forth above and verify that all information submitted in this application to be true and correct. Further, I/we understand and agree that my/our electronic signature(s) is/are the equivalent of a manual signature and that Gold Crest Metals may rely upon it/them as such.

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