www.tradeviewlatam.com
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URL:
https://www.tradeviewlatam.com/it/forms/accounts/individual?ibla=230914
Submission: On October 09 via manual from IT — Scanned from IT
Submission: On October 09 via manual from IT — Scanned from IT
Form analysis 2 forms found in the DOM
POST ?processform=support&formtype=contact
<form method="POST" id="modalContactForm" action="?processform=support&formtype=contact" class="ajax needs-validation" novalidate="">
<div class="form-group">
<label for="contactFormName"><span class="text-primary">*</span>Nombre</label>
<input type="text" class="form-control" name="user_message[name]" id="contactFormName" data-custom-user-form="name" placeholder="Nombre" required="">
</div>
<div class="form-group">
<label for="contactFormEmail"><span class="text-primary">*</span>E-mail</label>
<input type="email" class="form-control" name="user_message[email]" id="contactFormEmail" data-custom-user-form="email" placeholder="E-mail" required="">
</div>
<div class="form-group">
<label for="contactFormMessage"><span class="text-primary">*</span>Mensaje</label>
<textarea class="form-control" name="user_message[message]" id="contactFormMessage" rows="3" required=""></textarea>
</div>
<button type="submit" class="btn btn-primary" style="float:left;">Enviar</button>
<button type="button" class="btn btn-secondary" data-dismiss="modal" style="float:right;">Cerrar</button>
<div class="loader" style="display:none"></div>
<input type="hidden" name="backend[form_link]" value="https://www.tradeviewlatam.com/it/forms/accounts/individual?ibla=230914">
<input type="hidden" name="backend[user][email]">
<input type="hidden" name="backend[user][name]">
<input type="hidden" name="gCaptchaAction" value="accountsopenaccountindividual">
<input type="hidden" name="gReCaptcha">
<div class="alert responseMessage alert-primary alert-dismissible fade show mt-4 d-none" role="alert">
<span class="message">Message</span>
<button type="button" class="close" data-dismiss="alert" aria-label="Close">
<span aria-hidden="true">×</span>
</button>
</div>
</form>POST https://www.tradeviewlatam.com/forms/accounts/individual?processform=agreement&formtype=individual
<form enctype="multipart/form-data" method="POST" id="individualForm" class="col-md-12 materializeForm" action="https://www.tradeviewlatam.com/forms/accounts/individual?processform=agreement&formtype=individual" autocomplete="off" novalidate="">
<input type="hidden" name="hubspot_form_id" value="a292b1f0-8640-47af-bb7a-555a77015956">
<input type="hidden" name="slug" value="/accounts/open/individual">
<input type="hidden" name="meta_title" value="Latam Cuenta Individual">
<!--Personal information-->
<div class="row fieldContainer">
<div class="col-md-6">
<fieldset class="input">
<label class="control-label selectLabel" for="platform"><span class="text-primary">*</span>Seleccione una Plataforma</label>
<div class="dropdown bootstrap-select float-right"><select class="selectpicker float-right" name="basic_information[platform]" required="" tabindex="-98">
<option value="" selected="" disabled="">Plataforma...</option>
<option value="" disabled="" class="option-title">FX PLATFORMS</option>
<option value="Tradeview MT4 Innovative Liquidity Connector">Tradeview MT4 Innovative Liquidity Connector</option>
<option value="Tradeview MT4 X Leverage">Tradeview MT4 X Leverage</option>
<option value="Tradeview MT5 Innovative Liquidity Connector">Tradeview MT5 Innovative Liquidity Connector</option>
<option value="Tradeview MT5 X Leverage">Tradeview MT5 X Leverage</option>
<option value="Tradeview cTrader">Tradeview cTrader</option>
<option value="" disabled="" class="option-divider"></option>
<option value="" disabled="" class="option-title">EQUITY PLATFORMS</option>
<option value="Sterling Trader - USA On-Exchange Equities">Sterling Trader - USA On-Exchange Equities</option>
<option value="Tradeview Lightspeed">Tradeview Lightspeed</option>
<option value="DAS">DAS Trader - On Exchange Equities</option>
<option value="Takion">Takion</option>
<option value="Tradeview MT5 Equities">Tradeview MT5 Equities</option>
<option value="" disabled="" class="option-divider"></option>
<option value="Futures">Futures</option>
<option value="" disabled="" class="option-divider"></option>
<option value="Other - API or FIX Integration">Other - API or FIX Integration</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="button" title="Plataforma...">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Plataforma...</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-6">
<fieldset class="input">
<label class="control-label selectLabel" for="currency"><span class="text-primary">*</span>Tipo de Moneda</label>
<div class="dropdown bootstrap-select float-right"><select class="selectpicker float-right" name="basic_information[currency]" required="" tabindex="-98">
<option value="" selected="" disabled="">Seleccione una Moneda</option>
<option value="AUD">AUD</option>
<option value="CAD">CAD</option>
<option value="CHF">CHF</option>
<option value="EUR">EUR</option>
<option value="GBP">GBP</option>
<option value="USD">USD</option>
<option value="JPY">JPY</option>
<option value="MXN">MXN</option>
<option value="ZAR">ZAR</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="button" title="Seleccione una Moneda">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Seleccione una Moneda</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
</div>
<div class="row fieldContainer">
<legend class="col-md-12">Información del Titular de la Cuenta Primaria</legend>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="primary_holder[last_name]" class="form-control" placeholder="*Apellido" required="">
<label class="control-label" for="primary_holder[last_name]"><span class="text-primary">*</span>Apellido:</label>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="primary_holder[first_name]" class="form-control" data-custom-user-form="name" placeholder="*Primer Nombre" required="">
<label class="control-label" for="primary_holder[first_name]"><span class="text-primary">*</span>Primer Nombre:</label>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="primary_holder[middle_name]" class="form-control" placeholder="Segundo Nombre">
<label class="control-label" for="primary_holder[middle_name]">Segundo Nombre:</label>
</fieldset>
</div>
</div>
<div class="row fieldContainer">
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="primary_holder[place_of_birth]"><span class="text-primary">*</span>Lugar de Nacimiento</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="primary_holder[place_of_birth]" data-size="10" data-live-search="true" required="" tabindex="-98">
<option value="" selected="" disabled="">Lugar de Nacimiento</option>
<option value="Afghanistan">Afghanistan</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Antigua & Deps">Antigua & Deps</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bosnia Herzegovina">Bosnia Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Brazil">Brazil</option>
<option value="British Virgin Islands">British Virgin Islands</option>
<option value="Brunei">Brunei</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina">Burkina</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Island">Cayman Island</option>
<option value="Central African Rep">Central African Rep</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="Colombia">Colombia</option>
<option value="China">China</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo (Democratic Rep)">Congo (Democratic Rep)</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="East Timor">East Timor</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Greece">Greece</option>
<option value="Grenada">Grenada</option>
<option value="Guatemala">Guatemala</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Honduras">Honduras</option>
<option value="Hong-Kong">Hong-Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran">Iran</option>
<option value="Iraq">Iraq</option>
<option value="Ireland (Republic)">Ireland (Republic)</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Ivory Coast">Ivory Coast</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea North">Korea North</option>
<option value="Korea South">Korea South</option>
<option value="Kosovo">Kosovo</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Laos">Laos</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macedonia">Macedonia</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia">Micronesia</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar, (Burma)">Myanmar, (Burma)</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestinian Territory">Palestinian Territory</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Qatar">Qatar</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="St Kitts & Nevis">St Kitts & Nevis</option>
<option value="St Lucia">St Lucia</option>
<option value="Saint Vincent & the Grenadines the Grenadines">Saint Vincent & the Grenadines the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome & Principe">Sao Tome & Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syria">Syria</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailand">Thailand</option>
<option value="Togo">Togo</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad & Tobago">Trinidad & Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States">United States</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Vatican City">Vatican City</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="button" title="Lugar de Nacimiento">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Lugar de Nacimiento</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="bs-searchbox"><input type="text" class="form-control" autocomplete="off" role="textbox" aria-label="Search"></div>
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label><span class="text-primary">*</span>Día de Nacimiento</label>
<div class="threeDropdowns">
<div class="left-block">
<div class="dropdown bootstrap-select"><select name="primary_holder[birth_day]" class="selectpicker" required="" tabindex="-98">
<option value="" selected="" disabled="">Día</option>
<option value="01">01</option>
<option value="02">02</option>
<option value="03">03</option>
<option value="04">04</option>
<option value="05">05</option>
<option value="06">06</option>
<option value="07">07</option>
<option value="08">08</option>
<option value="09">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="button" title="Día">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Día</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</div>
<div class="left-block">
<div class="dropdown bootstrap-select"><select name="primary_holder[birth_month]" class="selectpicker" required="" tabindex="-98">
<option value="" selected="" disabled="">Mes</option>
<option value="01">Jan</option>
<option value="02">Feb</option>
<option value="03">Mar</option>
<option value="04">Apr</option>
<option value="05">May</option>
<option value="06">Jun</option>
<option value="07">Jul</option>
<option value="08">Aug</option>
<option value="09">Sep</option>
<option value="10">Oct</option>
<option value="11">Nov</option>
<option value="12">Dec</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="button" title="Mes">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Mes</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</div>
<div>
<div class="dropdown bootstrap-select"><select name="primary_holder[birth_year]" class="selectpicker" data-size="10" data-live-search="true" required="" tabindex="-98">
<option class="selectpicker" value="" selected="" disabled="">Año</option>
<option value="2005">2005</option>
<option value="2004">2004</option>
<option value="2003">2003</option>
<option value="2002">2002</option>
<option value="2001">2001</option>
<option value="2000">2000</option>
<option value="1999">1999</option>
<option value="1998">1998</option>
<option value="1997">1997</option>
<option value="1996">1996</option>
<option value="1995">1995</option>
<option value="1994">1994</option>
<option value="1993">1993</option>
<option value="1992">1992</option>
<option value="1991">1991</option>
<option value="1990">1990</option>
<option value="1989">1989</option>
<option value="1988">1988</option>
<option value="1987">1987</option>
<option value="1986">1986</option>
<option value="1985">1985</option>
<option value="1984">1984</option>
<option value="1983">1983</option>
<option value="1982">1982</option>
<option value="1981">1981</option>
<option value="1980">1980</option>
<option value="1979">1979</option>
<option value="1978">1978</option>
<option value="1977">1977</option>
<option value="1976">1976</option>
<option value="1975">1975</option>
<option value="1974">1974</option>
<option value="1973">1973</option>
<option value="1972">1972</option>
<option value="1971">1971</option>
<option value="1970">1970</option>
<option value="1969">1969</option>
<option value="1968">1968</option>
<option value="1967">1967</option>
<option value="1966">1966</option>
<option value="1965">1965</option>
<option value="1964">1964</option>
<option value="1963">1963</option>
<option value="1962">1962</option>
<option value="1961">1961</option>
<option value="1960">1960</option>
<option value="1959">1959</option>
<option value="1958">1958</option>
<option value="1957">1957</option>
<option value="1956">1956</option>
<option value="1955">1955</option>
<option value="1954">1954</option>
<option value="1953">1953</option>
<option value="1952">1952</option>
<option value="1951">1951</option>
<option value="1950">1950</option>
<option value="1949">1949</option>
<option value="1948">1948</option>
<option value="1947">1947</option>
<option value="1946">1946</option>
<option value="1945">1945</option>
<option value="1944">1944</option>
<option value="1943">1943</option>
<option value="1942">1942</option>
<option value="1941">1941</option>
<option value="1940">1940</option>
<option value="1939">1939</option>
<option value="1938">1938</option>
<option value="1937">1937</option>
<option value="1936">1936</option>
<option value="1935">1935</option>
<option value="1934">1934</option>
<option value="1933">1933</option>
<option value="1932">1932</option>
<option value="1931">1931</option>
<option value="1930">1930</option>
<option value="1929">1929</option>
<option value="1928">1928</option>
<option value="1927">1927</option>
<option value="1926">1926</option>
<option value="1925">1925</option>
<option value="1924">1924</option>
<option value="1923">1923</option>
<option value="1922">1922</option>
<option value="1921">1921</option>
<option value="1920">1920</option>
<option value="1919">1919</option>
<option value="1918">1918</option>
<option value="1917">1917</option>
<option value="1916">1916</option>
<option value="1915">1915</option>
<option value="1914">1914</option>
<option value="1913">1913</option>
<option value="1912">1912</option>
<option value="1911">1911</option>
<option value="1910">1910</option>
<option value="1909">1909</option>
<option value="1908">1908</option>
<option value="1907">1907</option>
<option value="1906">1906</option>
<option value="1905">1905</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="button" title="Año">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Año</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="bs-searchbox"><input type="text" class="form-control" autocomplete="off" role="textbox" aria-label="Search"></div>
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="primary_holder[passport]" class="form-control" placeholder="Pasaporte N°">
<label class="control-label" for="passport">Pasaporte N°</label>
</fieldset>
</div>
</div>
<div class="row fieldContainer">
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label">Fecha de Expiración del Pasaporte</label>
<div class="threeDropdowns">
<div class="left-block">
<div class="dropdown bootstrap-select"><select name="primary_holder[exp_day]" class="selectpicker" tabindex="-98">
<option value="" selected="" disabled="">Día</option>
<option value="01">01</option>
<option value="02">02</option>
<option value="03">03</option>
<option value="04">04</option>
<option value="05">05</option>
<option value="06">06</option>
<option value="07">07</option>
<option value="08">08</option>
<option value="09">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="button" title="Día">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Día</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</div>
<div class="left-block">
<div class="dropdown bootstrap-select"><select name="primary_holder[exp_month]" class="selectpicker" tabindex="-98">
<option value="" selected="" disabled="">Mes</option>
<option value="01">Jan</option>
<option value="02">Feb</option>
<option value="03">Mar</option>
<option value="04">Apr</option>
<option value="05">May</option>
<option value="06">Jun</option>
<option value="07">Jul</option>
<option value="08">Aug</option>
<option value="09">Sep</option>
<option value="10">Oct</option>
<option value="11">Nov</option>
<option value="12">Dec</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="button" title="Mes">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Mes</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</div>
<div>
<div class="dropdown bootstrap-select"><select name="primary_holder[exp_year]" class="selectpicker" data-size="10" data-live-search="true" tabindex="-98">
<option value="" selected="" disabled="">Año</option>
<option value="2023">2023</option>
<option value="2024">2024</option>
<option value="2025">2025</option>
<option value="2026">2026</option>
<option value="2027">2027</option>
<option value="2028">2028</option>
<option value="2029">2029</option>
<option value="2030">2030</option>
<option value="2031">2031</option>
<option value="2032">2032</option>
<option value="2033">2033</option>
<option value="2034">2034</option>
<option value="2035">2035</option>
<option value="2036">2036</option>
<option value="2037">2037</option>
<option value="2038">2038</option>
<option value="2039">2039</option>
<option value="2040">2040</option>
<option value="2041">2041</option>
<option value="2042">2042</option>
<option value="2043">2043</option>
<option value="2044">2044</option>
<option value="2045">2045</option>
<option value="2046">2046</option>
<option value="2047">2047</option>
<option value="2048">2048</option>
<option value="2049">2049</option>
<option value="2050">2050</option>
<option value="2051">2051</option>
<option value="2052">2052</option>
<option value="2053">2053</option>
<option value="2054">2054</option>
<option value="2055">2055</option>
<option value="2056">2056</option>
<option value="2057">2057</option>
<option value="2058">2058</option>
<option value="2059">2059</option>
<option value="2060">2060</option>
<option value="2061">2061</option>
<option value="2062">2062</option>
<option value="2063">2063</option>
<option value="2064">2064</option>
<option value="2065">2065</option>
<option value="2066">2066</option>
<option value="2067">2067</option>
<option value="2068">2068</option>
<option value="2069">2069</option>
<option value="2070">2070</option>
<option value="2071">2071</option>
<option value="2072">2072</option>
<option value="2073">2073</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="button" title="Año">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Año</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="bs-searchbox"><input type="text" class="form-control" autocomplete="off" role="textbox" aria-label="Search"></div>
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="primary_holder[nationality]"><span class="text-primary">*</span>Nacionalidad</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="primary_holder[nationality]" data-size="10" data-live-search="true" required="" tabindex="-98">
<option value="" selected="" disabled="">Nacionalidad</option>
<option value="Afghanistan">Afghanistan</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Antigua & Deps">Antigua & Deps</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bosnia Herzegovina">Bosnia Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Brazil">Brazil</option>
<option value="British Virgin Islands">British Virgin Islands</option>
<option value="Brunei">Brunei</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina">Burkina</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Island">Cayman Island</option>
<option value="Central African Rep">Central African Rep</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="Colombia">Colombia</option>
<option value="China">China</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo (Democratic Rep)">Congo (Democratic Rep)</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="East Timor">East Timor</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Greece">Greece</option>
<option value="Grenada">Grenada</option>
<option value="Guatemala">Guatemala</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Honduras">Honduras</option>
<option value="Hong-Kong">Hong-Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran">Iran</option>
<option value="Iraq">Iraq</option>
<option value="Ireland (Republic)">Ireland (Republic)</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Ivory Coast">Ivory Coast</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea North">Korea North</option>
<option value="Korea South">Korea South</option>
<option value="Kosovo">Kosovo</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Laos">Laos</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macedonia">Macedonia</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia">Micronesia</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar, (Burma)">Myanmar, (Burma)</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestinian Territory">Palestinian Territory</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Qatar">Qatar</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="St Kitts & Nevis">St Kitts & Nevis</option>
<option value="St Lucia">St Lucia</option>
<option value="Saint Vincent & the Grenadines the Grenadines">Saint Vincent & the Grenadines the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome & Principe">Sao Tome & Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syria">Syria</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailand">Thailand</option>
<option value="Togo">Togo</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad & Tobago">Trinidad & Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States">United States</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Vatican City">Vatican City</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="button" title="Nacionalidad">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Nacionalidad</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="bs-searchbox"><input type="text" class="form-control" autocomplete="off" role="textbox" aria-label="Search"></div>
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
</div>
<div class="row fieldContainer">
<div class="col-md-12">
<p class="warningParagraph">Información de Dirección</p>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="primary_holder[country]"><span class="text-primary">*</span>País</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="primary_holder[country]" data-size="10" data-live-search="true" required="" tabindex="-98">
<option value="" selected="" disabled="">País</option>
<option value="Afghanistan">Afghanistan</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Antigua & Deps">Antigua & Deps</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bosnia Herzegovina">Bosnia Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Brazil">Brazil</option>
<option value="British Virgin Islands">British Virgin Islands</option>
<option value="Brunei">Brunei</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina">Burkina</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Island">Cayman Island</option>
<option value="Central African Rep">Central African Rep</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="Colombia">Colombia</option>
<option value="China">China</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo (Democratic Rep)">Congo (Democratic Rep)</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="East Timor">East Timor</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Greece">Greece</option>
<option value="Grenada">Grenada</option>
<option value="Guatemala">Guatemala</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Honduras">Honduras</option>
<option value="Hong-Kong">Hong-Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran">Iran</option>
<option value="Iraq">Iraq</option>
<option value="Ireland (Republic)">Ireland (Republic)</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Ivory Coast">Ivory Coast</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea North">Korea North</option>
<option value="Korea South">Korea South</option>
<option value="Kosovo">Kosovo</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Laos">Laos</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macedonia">Macedonia</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia">Micronesia</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar, (Burma)">Myanmar, (Burma)</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestinian Territory">Palestinian Territory</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Qatar">Qatar</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="St Kitts & Nevis">St Kitts & Nevis</option>
<option value="St Lucia">St Lucia</option>
<option value="Saint Vincent & the Grenadines the Grenadines">Saint Vincent & the Grenadines the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome & Principe">Sao Tome & Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syria">Syria</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailand">Thailand</option>
<option value="Togo">Togo</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad & Tobago">Trinidad & Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States">United States</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Vatican City">Vatican City</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="button" title="País">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">País</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="bs-searchbox"><input type="text" class="form-control" autocomplete="off" role="textbox" aria-label="Search"></div>
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-4 spaceFields writeProvinces">
<fieldset class="input">
<input type="text" name="primary_holder[province]" class="form-control" placeholder="Provincia">
<label class="control-label" for="primary_holder[province]"><span class="text-primary">*</span>Provincia</label>
</fieldset>
</div>
<div class="col-md-4 spaceFields japanProvinces" style="display:none">
<fieldset class="input">
<label class="control-label" for="primary_holder[province]"><span class="text-primary">*</span>Provincia</label>
<div class="dropdown bootstrap-select form-control provinceSelect"><select class="form-control provinceSelect selectpicker" name="primary_holder[province]" data-size="10" data-live-search="true" tabindex="-98">
<option value="" selected="" disabled="">Provincia</option>
<option value="Hokkaido">北海道</option>
<option value="Aomori">青森県</option>
<option value="Iwate">岩手県</option>
<option value="Miyagi">宮城県</option>
<option value="Akita">秋田県</option>
<option value="Yamagata">山形県</option>
<option value="Fukushima">福島県</option>
<option value="Ibaraki">茨城県</option>
<option value="Tochigi">栃木県</option>
<option value="Gunma">群馬県</option>
<option value="Saitama">埼玉県</option>
<option value="Chiba">千葉県</option>
<option value="Tokyo">東京都</option>
<option value="Kanagawa">神奈川県</option>
<option value="Niigata">新潟県</option>
<option value="Toyama">富山県</option>
<option value="Fukui">福井県</option>
<option value="Ishikawa ">石川県</option>
<option value="Yamanashi">山梨県</option>
<option value="Nagano">長野県</option>
<option value="Gifu">岐阜県</option>
<option value="Shizuoka">静岡県</option>
<option value="Aichi">愛知県</option>
<option value="Mie">三重県</option>
<option value="Shiga">滋賀県</option>
<option value="Kyoto">京都府</option>
<option value="Osaka">大阪府</option>
<option value="Hyogo">兵庫県</option>
<option value="Nara">奈良県</option>
<option value="Wakayama">和歌山県</option>
<option value="Tottori">鳥取県</option>
<option value="Shimane">島根県</option>
<option value="Okayama">岡山県</option>
<option value="Hiroshima">広島県</option>
<option value="Yamaguchi">山口県</option>
<option value="Tokushima">徳島県</option>
<option value="Kagawa">香川県</option>
<option value="Ehime">愛媛県</option>
<option value="Kochi">高知県</option>
<option value="Fukuoka">福岡県</option>
<option value="Miyazaki">宮崎県</option>
<option value="Nagasaki">長崎県</option>
<option value="Kumamoto">熊本県</option>
<option value="Kagoshima">鹿児島県</option>
<option value="Saga">佐賀県</option>
<option value="Oita">大分県</option>
<option value="Okinawa">沖縄県</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="button" title="Provincia">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Provincia</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="bs-searchbox"><input type="text" class="form-control" autocomplete="off" role="textbox" aria-label="Search"></div>
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="primary_holder[city]" class="form-control" placeholder="*Ciudad" required="">
<label class="control-label" for="primary_holder[city]"><span class="text-primary">*</span>Ciudad:</label>
</fieldset>
</div>
</div>
<div class="row fieldContainer">
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="primary_holder[address]" class="form-control" placeholder="*Dirección" required="">
<label class="control-label" for="primary_holder[address]"><span class="text-primary">*</span>Dirección:</label>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="primary_holder[address2]" class="form-control" placeholder="Dirección 2">
<label class="control-label" for="primary_holder[address2]">Dirección 2</label>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="primary_holder[zip_code]" class="form-control" placeholder="*Código Postal" required="">
<label class="control-label" for="primary_holder[zip_code]"><span class="text-primary">*</span>Código Postal</label>
</fieldset>
</div>
</div>
<div class="row fieldContainer">
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="number" name="primary_holder[phone]" class="form-control" placeholder="*Teléfono" required="">
<label class="control-label" for="primary_holder[phone]"><span class="text-primary">*</span>Teléfono</label>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="number" name="primary_holder[cellphone]" class="form-control" placeholder="Móvil">
<label class="control-label" for="primary_holder[cellphone]">Móvil</label>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="email" name="primary_holder[email]" class="form-control" data-custom-user-form="email" placeholder="*E-mail" value="" required="">
<label class="control-label" for="primary_holder[email]"><span class="text-primary">*</span>E-mail</label>
</fieldset>
</div>
<div class="col-md-4 spaceFields top-spaceFields">
<div class="midField">
<fieldset class="input">
<label class="control-label"><span class="text-primary">*</span>Género</label>
<div class="dropdown bootstrap-select dropup" style="width: 112px;"><select name="primary_holder[gender]" class="selectpicker" data-width="auto" required="" tabindex="-98">
<option value="Male">Masculino</option>
<option value="Female">Femenino</option>
<option value="Other">Otro</option>
</select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="button" title="Masculino">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Masculino</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox" style="min-width: 0px; max-height: 1019px; overflow: hidden; min-height: 0px;">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1" style="max-height: 1001px; overflow-y: auto; min-height: 0px;">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="midField">
<fieldset class="input">
<label class="control-label" for="primary_holder[marital_status]"><span class="text-primary">*</span>Estado Civil</label>
<div class="dropdown bootstrap-select dropup" style="width: 110px;"><select name="primary_holder[marital_status]" class="selectpicker" data-width="auto" required="" tabindex="-98">
<option value="Single">Soltero(a)</option>
<option value="Married">Casado(a)</option>
</select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="button" title="Soltero(a)">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Soltero(a)</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox" style="min-width: 0px; max-height: 1019px; overflow: hidden; min-height: 0px;">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1" style="max-height: 1001px; overflow-y: auto; min-height: 0px;">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
</div>
</div>
<!--end personal information-->
<!--bank information-->
<!-- <div class="row fieldContainer">
<legend class="col-md-12">Información Bancaria</legend>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="bank_information[bank_name]" class="form-control" placeholder="Nombre del Banco">
<label class="control-label" for="bank_information[bank_name]">Nombre del Banco</label>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="bank_information[bank_address]" class="form-control" placeholder="Dirección del Banco">
<label class="control-label" for="bank_information[bank_address]">Dirección del Banco</label>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="bank_information[bank_swift]" class="form-control" placeholder="SWIFT/Código Bancario">
<label class="control-label" for="bank_information[bank_swift]">SWIFT/Código Bancario</label>
</fieldset>
</div>
</div>
<div class="row fieldContainer">
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="bank_information[account_number]" class="form-control" placeholder="Número de Cuenta (Si aplica)">
<label class="control-label" for="bank_information[account_number]">Número de Cuenta (Si aplica)</label>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="bank_information[account_holder_name]" class="form-control" placeholder="Nombre del Beneficiario">
<label class="control-label" for="bank_information[account_holder_name]">Nombre del Beneficiario</label>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="bank_information[correspondient_bank]" class="form-control" placeholder="Banco Correspondiente">
<label class="control-label" for="bank_information[correspondient_bank]">Banco Correspondiente</label>
</fieldset>
</div>
</div> -->
<!--end bank information-->
<!--Taxes Info-->
<div class="row fieldContainer">
<legend class="col-md-12">Declaración de Ciudadanía o Residencia Estadounidense para propósitos de impuestos</legend>
<div class="col-md-12 spaceFields">
<p class="warningParagraph">Por favor marque entre las opciones (a), (b) o (c) y complete de manera apropiada</p>
<label class="control-label text-muted ml-3"><span class="text-primary">*</span> Declaración:</label>
<div class="custom-control custom-radio ml-5">
<input id="citizenship_declaration[declaration]a" name="citizenship_declaration[declaration]" class="custom-control-input" required="" type="radio"
value="(a) I confirm that I am a U.S. citizen and/or resident in the U.S. for tax purposes (green card holder or resident under the substantial presence test) and my U.S. federal taxpayer identifying number (U.S TIN) is as follows.">
<label class="custom-control-label text-muted" for="citizenship_declaration[declaration]a">(a) Confirmo que soy un ciudadano o residente estadounidense para propósitos de impuestos (poseedor de Green Card o residente bajo el test sustancial
de presencia) así como lo es mi número de identificación de pago de impuestos federal (U.S TIN).</label>
</div>
<div class="custom-control custom-radio ml-5">
<input id="citizenship_declaration[declaration]b" name="citizenship_declaration[declaration]" class="custom-control-input" required="" type="radio"
value="(b) I confirm that I was born in the U.S. (or a U.S. territory) but am no longer a U.S. citizen as I have voluntary surrendered my citizenship as evidenced by the attached documents.">
<label class="custom-control-label text-muted" for="citizenship_declaration[declaration]b">(b) Confirmo que nací en los Estados Unidos (o en territorio estadounidense) pero ya no soy ciudadano estadounidense puesto que he renunciado
voluntariamente a mi ciudadanía como se evidencia en los documentos adjuntos.</label>
</div>
<div class="custom-control custom-radio ml-5">
<input id="citizenship_declaration[declaration]c" name="citizenship_declaration[declaration]" class="custom-control-input" required="" type="radio" value="Not US citizen">
<label class="custom-control-label text-muted" for="citizenship_declaration[declaration]c">(c) Confirmo que no soy ciudadano o residente estadounidense para propósitos de impuestos.</label>
</div>
</div>
</div>
<div id="DeclarationUSAtaxes" style="display:none">
<div class="row fieldContainer">
<legend class="col-md-12">Declaración de Residencia Fiscal (Diferente a los Estados Unidos)</legend>
<div class="col-md-12 spaceFields">
<p class="warningParagraph">Por la presente confirmo que soy, para propósitos de impuestos, residente en los siguientes países (indique el tipo y número de referencia que aplica en cada país)</p>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="citizenship_declaration[other_than_USA][1][country]"><span class="text-primary">*</span>País</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="citizenship_declaration[other_than_USA][1][country]" data-size="10" data-live-search="true" tabindex="-98">
<option value="" selected="" disabled="">País</option>
<option value="Afghanistan">Afghanistan</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Antigua & Deps">Antigua & Deps</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bosnia Herzegovina">Bosnia Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Brazil">Brazil</option>
<option value="British Virgin Islands">British Virgin Islands</option>
<option value="Brunei">Brunei</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina">Burkina</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Island">Cayman Island</option>
<option value="Central African Rep">Central African Rep</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="Colombia">Colombia</option>
<option value="China">China</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo (Democratic Rep)">Congo (Democratic Rep)</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="East Timor">East Timor</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Greece">Greece</option>
<option value="Grenada">Grenada</option>
<option value="Guatemala">Guatemala</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Honduras">Honduras</option>
<option value="Hong-Kong">Hong-Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran">Iran</option>
<option value="Iraq">Iraq</option>
<option value="Ireland (Republic)">Ireland (Republic)</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Ivory Coast">Ivory Coast</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea North">Korea North</option>
<option value="Korea South">Korea South</option>
<option value="Kosovo">Kosovo</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Laos">Laos</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macedonia">Macedonia</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia">Micronesia</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar, (Burma)">Myanmar, (Burma)</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestinian Territory">Palestinian Territory</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Qatar">Qatar</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="St Kitts & Nevis">St Kitts & Nevis</option>
<option value="St Lucia">St Lucia</option>
<option value="Saint Vincent & the Grenadines the Grenadines">Saint Vincent & the Grenadines the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome & Principe">Sao Tome & Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syria">Syria</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailand">Thailand</option>
<option value="Togo">Togo</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad & Tobago">Trinidad & Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States">United States</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Vatican City">Vatican City</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
<option value="N/A">N/A</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="button" title="País">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">País</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="bs-searchbox"><input type="text" class="form-control" autocomplete="off" role="textbox" aria-label="Search"></div>
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="citizenship_declaration[other_than_USA][1][type]" class="form-control" placeholder="Tipo de número de refencia de impuestos:">
<label class="control-label" for="citizenship_declaration[other_than_USA][1][type]"><span class="text-primary">*</span>Tipo de número de refencia de impuestos:</label>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="citizenship_declaration[other_than_USA][1][number]" class="form-control" placeholder="Número de Referencia de impuestos:">
<label class="control-label" for="citizenship_declaration[other_than_USA][1][number]"><span class="text-primary">*</span>Número de Referencia de impuestos:</label>
</fieldset>
</div>
</div>
<div class="row fieldContainer">
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="citizenship_declaration[other_than_USA][2][country]">País</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="citizenship_declaration[other_than_USA][2][country]" data-size="10" data-live-search="true" tabindex="-98">
<option value="" selected="" disabled="">País</option>
<option value="Afghanistan">Afghanistan</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Antigua & Deps">Antigua & Deps</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bosnia Herzegovina">Bosnia Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Brazil">Brazil</option>
<option value="British Virgin Islands">British Virgin Islands</option>
<option value="Brunei">Brunei</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina">Burkina</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Island">Cayman Island</option>
<option value="Central African Rep">Central African Rep</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="Colombia">Colombia</option>
<option value="China">China</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo (Democratic Rep)">Congo (Democratic Rep)</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="East Timor">East Timor</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Greece">Greece</option>
<option value="Grenada">Grenada</option>
<option value="Guatemala">Guatemala</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Honduras">Honduras</option>
<option value="Hong-Kong">Hong-Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran">Iran</option>
<option value="Iraq">Iraq</option>
<option value="Ireland (Republic)">Ireland (Republic)</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Ivory Coast">Ivory Coast</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea North">Korea North</option>
<option value="Korea South">Korea South</option>
<option value="Kosovo">Kosovo</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Laos">Laos</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macedonia">Macedonia</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia">Micronesia</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar, (Burma)">Myanmar, (Burma)</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestinian Territory">Palestinian Territory</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Qatar">Qatar</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="St Kitts & Nevis">St Kitts & Nevis</option>
<option value="St Lucia">St Lucia</option>
<option value="Saint Vincent & the Grenadines the Grenadines">Saint Vincent & the Grenadines the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome & Principe">Sao Tome & Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syria">Syria</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailand">Thailand</option>
<option value="Togo">Togo</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad & Tobago">Trinidad & Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States">United States</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Vatican City">Vatican City</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="button" title="País">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">País</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="bs-searchbox"><input type="text" class="form-control" autocomplete="off" role="textbox" aria-label="Search"></div>
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="citizenship_declaration[other_than_USA][2][type]" class="form-control" placeholder="Tipo de número de refencia de impuestos:">
<label class="control-label" for="citizenship_declaration[other_than_USA][2][type]">Tipo de número de refencia de impuestos:</label>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="citizenship_declaration[other_than_USA][2][number]" class="form-control" placeholder="Número de Referencia de impuestos:">
<label class="control-label" for="citizenship_declaration[other_than_USA][2][number]">Número de Referencia de impuestos:</label>
</fieldset>
</div>
</div>
<div class="row fieldContainer">
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="citizenship_declaration[other_than_USA][3][country]">País</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="citizenship_declaration[other_than_USA][3][country]" data-size="10" data-live-search="true" tabindex="-98">
<option value="" selected="" disabled="">País</option>
<option value="Afghanistan">Afghanistan</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Antigua & Deps">Antigua & Deps</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bosnia Herzegovina">Bosnia Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Brazil">Brazil</option>
<option value="British Virgin Islands">British Virgin Islands</option>
<option value="Brunei">Brunei</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina">Burkina</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Island">Cayman Island</option>
<option value="Central African Rep">Central African Rep</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="Colombia">Colombia</option>
<option value="China">China</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo (Democratic Rep)">Congo (Democratic Rep)</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="East Timor">East Timor</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Greece">Greece</option>
<option value="Grenada">Grenada</option>
<option value="Guatemala">Guatemala</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Honduras">Honduras</option>
<option value="Hong-Kong">Hong-Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran">Iran</option>
<option value="Iraq">Iraq</option>
<option value="Ireland (Republic)">Ireland (Republic)</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Ivory Coast">Ivory Coast</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea North">Korea North</option>
<option value="Korea South">Korea South</option>
<option value="Kosovo">Kosovo</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Laos">Laos</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macedonia">Macedonia</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia">Micronesia</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar, (Burma)">Myanmar, (Burma)</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestinian Territory">Palestinian Territory</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Qatar">Qatar</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="St Kitts & Nevis">St Kitts & Nevis</option>
<option value="St Lucia">St Lucia</option>
<option value="Saint Vincent & the Grenadines the Grenadines">Saint Vincent & the Grenadines the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome & Principe">Sao Tome & Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syria">Syria</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailand">Thailand</option>
<option value="Togo">Togo</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad & Tobago">Trinidad & Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States">United States</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Vatican City">Vatican City</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="button" title="País">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">País</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="bs-searchbox"><input type="text" class="form-control" autocomplete="off" role="textbox" aria-label="Search"></div>
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="citizenship_declaration[other_than_USA][3][type]" class="form-control" placeholder="Tipo de número de refencia de impuestos:">
<label class="control-label" for="citizenship_declaration[other_than_USA][3][type]">Tipo de número de refencia de impuestos:</label>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="citizenship_declaration[other_than_USA][3][number]" class="form-control" placeholder="Número de Referencia de impuestos:">
<label class="control-label" for="citizenship_declaration[other_than_USA][3][number]">Número de Referencia de impuestos:</label>
</fieldset>
</div>
</div>
</div>
<!-- end Taxes Info -->
<!--employment information-->
<div class="row fieldContainer">
<legend class="col-md-12">Información de Empleo</legend>
<div class="col-md-6 spaceFields">
<label class="control-label ml-3 text-muted"><span class="text-primary">*</span> Estado Laboral</label>
<div class="custom-control custom-radio ml-5">
<input type="radio" name="employment_information[status]" class="custom-control-input" id="empStatus0" value="Employed" required="">
<label class="custom-control-label text-muted" for="empStatus0">Empleado</label>
</div>
<div class="custom-control custom-radio ml-5">
<input type="radio" name="employment_information[status]" class="custom-control-input" id="empStatus1" value="Self Employed" required="">
<label class="custom-control-label text-muted" for="empStatus1">Independiente</label>
</div>
<div class="custom-control custom-radio ml-5">
<input type="radio" name="employment_information[status]" class="custom-control-input" id="empStatus2" value="Retired" required="">
<label class="custom-control-label text-muted" for="empStatus2">Retirado</label>
</div>
<div class="custom-control custom-radio ml-5">
<input type="radio" name="employment_information[status]" class="custom-control-input" id="empStatus3" value="Unemployed" required="">
<label class="custom-control-label text-muted" for="empStatus3">Desempleado</label>
</div>
</div>
<div class="col-md-6 spaceFields">
<label class="control-label ml-3 text-muted"><span class="text-primary">*</span> Salario Anual:</label>
<div class="custom-control custom-radio ml-5">
<input type="radio" name="employment_information[salary]" class="custom-control-input" id="empSalary0" value="Less than $25,000" required="">
<label class="custom-control-label text-muted" for="empSalary0">Menos de $25,000 Firmar</label>
</div>
<div class="custom-control custom-radio ml-5">
<input type="radio" name="employment_information[salary]" class="custom-control-input" id="empSalary1" value="$25,000 to $50,000" required="">
<label class="custom-control-label text-muted" for="empSalary1">$25,000 hasta $50,000</label>
</div>
<div class="custom-control custom-radio ml-5">
<input type="radio" name="employment_information[salary]" class="custom-control-input" id="empSalary2" value="$50,000 to $100,000" required="">
<label class="custom-control-label text-muted" for="empSalary2">$50,000 hasta $100,000</label>
</div>
<div class="custom-control custom-radio ml-5">
<input type="radio" name="employment_information[salary]" class="custom-control-input" id="empSalary3" value="Over $ 100,000" required="">
<label class="custom-control-label text-muted" for="empSalary3">Más de $ 100,000</label>
</div>
</div>
</div>
<div id="selfEmployedData" style="display:none;">
<div class="row fieldContainer">
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="employment_information[self-employed][type_of_business]" class="form-control" placeholder="Tipo de negocio">
<label class="control-label"><span class="text-danger">*</span>Tipo de negocio</label>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="employment_information[self-employed][industry]" class="form-control" placeholder="Industria"> <label class="control-label"><span class="text-danger">*</span>Industria</label>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="employment_information[self-employed][location_of_business]" class="form-control" placeholder="Ubicación de la empresa">
<label class="control-label"><span class="text-danger">*</span>Ubicación de la empresa</label>
<i class="fa fa-users" aria-hidden="true"></i>
</fieldset>
</div>
</div>
<div class="row fieldContainer">
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="employment_information[self-employed][name_of_business]" class="form-control" placeholder="Nombre del negocio">
<label class="control-label"><span class="text-danger">*</span>Nombre del negocio</label>
<i class="fa fa-user" aria-hidden="true"></i>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="employment_information[self-employed][link_to_business_website]" class="form-control" placeholder="Enlace al sitio web de la empresa">
<label class="control-label">Enlace al sitio web de la empresa</label>
<i class="fa fa-users" aria-hidden="true"></i>
</fieldset>
</div>
</div>
</div>
<div id="EmployerInformation" style="display:none;">
<div class="row fieldContainer">
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="employment_information[employed][employer]" class="form-control" placeholder="Empleador:">
<label class="control-label" for="employer"><span class="text-primary">*</span>Empleador:</label>
<i class="fa fa-user" aria-hidden="true"></i>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<i class="fa fa-users" aria-hidden="true"></i>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="employment_information[employed][nature_of_business]" class="form-control" placeholder="Naturaleza del Negocio">
<label class="control-label" for="natureOfBusiness"><span class="text-primary">*</span>Naturaleza del Negocio</label>
<i class="fa fa-users" aria-hidden="true"></i>
</fieldset>
</div>
</div>
<div class="row fieldContainer">
<div class="col-md-4 spaceFields">
<fieldset class="input">
<i class="fa fa-users" aria-hidden="true"></i>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="employment_information[employed][address]" class="form-control" placeholder="Dirección del Empleador">
<label class="control-label" for="empStreet1"><span class="text-primary">*</span>Dirección del Empleador</label>
<i class="fa fa-map-marker" aria-hidden="true"></i>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="employment_information[employed][address_2]" class="form-control" placeholder="Dirección del Empleador #2">
<label class="control-label" for="empStreet2">Dirección del Empleador #2</label>
<i class="fa fa-map-marker" aria-hidden="true"></i>
</fieldset>
</div>
</div>
<div class="row fieldContainer">
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="employment_information[employed][city]" class="form-control" placeholder="Ciudad del Empleador">
<label class="control-label" for="empCity"><span class="text-primary">*</span>Ciudad del Empleador</label>
<i class="fa fa-map-o" aria-hidden="true"></i>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="employment_information[employed][state]" class="form-control" placeholder="Provincia / Estado del empleador">
<label class="control-label" for="empState"><span class="text-primary">*</span>Provincia / Estado del empleador</label>
<i class="fa fa-map" aria-hidden="true"></i>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="employment_information[employed][zip_code]" class="form-control" placeholder="Código Zip / Postal del Empleador">
<label class="control-label" for="empZip"><span class="text-primary">*</span>Código Zip / Postal del Empleador</label>
<i class="fa fa-map-pin" aria-hidden="true"></i>
</fieldset>
</div>
</div>
<div class="row fieldContainer">
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="text" name="employment_information[employed][country]" class="form-control" placeholder="País del Empleador">
<label class="control-label" for="empCountry"><span class="text-primary">*</span>País del Empleador</label>
<i class="fa fa-globe" aria-hidden="true"></i>
</fieldset>
</div>
</div>
</div>
<div id="unenployedSourceOfFounds" style="display:none;">
<div class="row fieldContainer">
<div class="col-md-12 spaceFields">
<p class="warningParagraph">(Por favor, suministre la información detallada incluyendo el país de origen. Frases como "transferido desde otra compañía" o "inversiones" no son suficientes. Si los recursos son derivados de la venta de un
negocio, la descripción debería indicar el nombre del negocio y las actividades de la compañía. Si los recursos fueron generados a través de ganancias acumuladas, la declaración jurada debería incluir información como su empleador, su
posición y el número de años trabajando. Los detalles específicos de la fuente de recursos introducidos son eseciales para que podamos confirmar que los fondos son legales desde el origen. Nos reservamos el derecho de solicitar
documentación adicional para dar soporte a esta declaración.)</p>
<fieldset class="input textarea" style="height: 25%;">
<textarea style="padding: 4px;" type="text" name="employment_information[source_of_funds]" rows="3" class="form-control" placeholder="Fuente de Recursos"></textarea>
<label class="control-label" for="sourceOfFunds"><span class="text-primary">*</span>Fuente de Recursos</label>
<i class="fa fa-user" aria-hidden="true"></i>
</fieldset>
</div>
</div>
</div>
<!--end employment information-->
<!-- Total assets -->
<div class="row fieldContainer">
<legend class="col-md-12">Activos Totales</legend>
<div class="col-md-4 spaceFields">
<label class="control-label ml-3 text-muted"><span class="text-primary">*</span> Ingresos Totales Anuales</label>
<div class="custom-control custom-radio ml-5">
<input type="radio" name="total_assets[annual_income]" class="custom-control-input" id="annualIncome0" value="Less than $25,000" required="">
<label class="custom-control-label text-muted" for="annualIncome0">Menos de $25,000 Firmar</label>
</div>
<div class="custom-control custom-radio ml-5">
<input type="radio" name="total_assets[annual_income]" class="custom-control-input" id="annualIncome1" value="$25,000 to $50,000" required="">
<label class="custom-control-label text-muted" for="annualIncome1">$25,000 hasta $50,000</label>
</div>
<div class="custom-control custom-radio ml-5">
<input type="radio" name="total_assets[annual_income]" class="custom-control-input" id="annualIncome2" value="$50,000 to $100,000" required="">
<label class="custom-control-label text-muted" for="annualIncome2">$50,000 hasta $100,000</label>
</div>
<div class="custom-control custom-radio ml-5">
<input type="radio" name="total_assets[annual_income]" class="custom-control-input" id="annualIncome3" value="Over $100,000" required="">
<label class="custom-control-label text-muted" for="annualIncome3">Más de $ 100,000</label>
</div>
</div>
<div class="col-md-4 spaceFields">
<label class="control-label ml-3 text-muted"><span class="text-primary">*</span> Valor Neto Aproximado</label>
<div class="custom-control custom-radio ml-5">
<input type="radio" name="total_assets[aprx_net_worth]" class="custom-control-input" id="aprxNetWorth0" value="Less than $25,000" required="">
<label class="custom-control-label text-muted" for="aprxNetWorth0">Menos de $25,000 Firmar</label>
</div>
<div class="custom-control custom-radio ml-5">
<input type="radio" name="total_assets[aprx_net_worth]" class="custom-control-input" id="aprxNetWorth1" value="$25,000 to $50,000" required="">
<label class="custom-control-label text-muted" for="aprxNetWorth1">$25,000 hasta $50,000</label>
</div>
<div class="custom-control custom-radio ml-5">
<input type="radio" name="total_assets[aprx_net_worth]" class="custom-control-input" id="aprxNetWorth2" value="$50,000 to $100,000" required="">
<label class="custom-control-label text-muted" for="aprxNetWorth2">$50,000 hasta $100,000</label>
</div>
<div class="custom-control custom-radio ml-5">
<input type="radio" name="total_assets[aprx_net_worth]" class="custom-control-input" id="aprxNetWorth3" value="Over $100,000" required="">
<label class="custom-control-label text-muted" for="aprxNetWorth3">Más de $ 100,000</label>
</div>
</div>
<div class="col-md-4 spaceFields">
<label class="control-label ml-3 text-muted"><span class="text-primary">*</span> Inversión Anticipada</label>
<div class="custom-control custom-radio ml-5">
<input type="radio" name="total_assets[anticipated_investment]" class="custom-control-input" id="anticipatedInvest0" value="Less than $25,000" required="">
<label class="custom-control-label text-muted" for="anticipatedInvest0">Menos de $25,000 Firmar</label>
</div>
<div class="custom-control custom-radio ml-5">
<input type="radio" name="total_assets[anticipated_investment]" class="custom-control-input" id="anticipatedInvest1" value="$25,000 to $50,000" required="">
<label class="custom-control-label text-muted" for="anticipatedInvest1">$25,000 hasta $50,000</label>
</div>
<div class="custom-control custom-radio ml-5">
<input type="radio" name="total_assets[anticipated_investment]" class="custom-control-input" id="anticipatedInvest2" value="$50,000 to $100,000" required="">
<label class="custom-control-label text-muted" for="anticipatedInvest2">$50,000 hasta $100,000</label>
</div>
<div class="custom-control custom-radio ml-5">
<input type="radio" name="total_assets[anticipated_investment]" class="custom-control-input" id="anticipatedInvest3" value="Over $100,000" required="">
<label class="custom-control-label text-muted" for="anticipatedInvest3">Más de $ 100,000</label>
</div>
</div>
</div>
<!-- End Total assets -->
<!--Declaration of Source of Wealth-->
<div class="row fieldContainer">
<legend class="col-md-12">Declaración de Recursos</legend>
<div class="col-md-12 spaceFields">
<label class="control-label ml-3 text-muted"><span class="text-primary">*</span> Recursos de fondos</label>
</div>
<div class="col-md-6 spaceFields">
<div class="custom-control custom-checkbox ml-5">
<input type="checkbox" name="source_of_wealth[selected][]" class="custom-control-input" id="sourceOfWealthSelect0" value="Income from profession/employment" required="">
<label class="custom-control-label text-muted" for="sourceOfWealthSelect0">Proviene de empleo / profesión</label>
</div>
<div class="custom-control custom-checkbox ml-5">
<input type="checkbox" name="source_of_wealth[selected][]" class="custom-control-input" id="sourceOfWealthSelect1" value="Inheritance or Divorce Settlement" required="">
<label class="custom-control-label text-muted" for="sourceOfWealthSelect1">Herencia o Divorcio</label>
</div>
<div class="custom-control custom-checkbox ml-5">
<input type="checkbox" name="source_of_wealth[selected][]" class="custom-control-input" id="sourceOfWealthSelect2" value="Company Ownership / Sale of Company or Assets" required="">
<label class="custom-control-label text-muted" for="sourceOfWealthSelect2">Venta de una compañía o sus acciones</label>
</div>
<div class="custom-control custom-checkbox ml-5">
<input type="checkbox" name="source_of_wealth[selected][]" class="custom-control-input" id="sourceOfWealthSelect3" value="Company Ownership and Profits" required="">
<label class="custom-control-label text-muted" for="sourceOfWealthSelect3">Propiedad de una compañía y sus beneficios</label>
</div>
<div class="custom-control custom-checkbox ml-5">
<input type="checkbox" name="source_of_wealth[selected][]" class="custom-control-input" id="sourceOfWealthSelect4" value="Investments or Savings" required="">
<label class="custom-control-label text-muted" for="sourceOfWealthSelect4">Inversiones o ahorros</label>
</div>
</div>
<div class="col-md-6 spaceFields ">
<div class="custom-control custom-checkbox ml-5">
<input type="checkbox" name="source_of_wealth[selected][]" class="custom-control-input" id="sourceOfWealthSelect5" value="Rental income / Sale of Real Property" required="">
<label class="custom-control-label text-muted" for="sourceOfWealthSelect5">Renta o venta de una propiedad</label>
</div>
<div class="custom-control custom-checkbox ml-5">
<input type="checkbox" name="source_of_wealth[selected][]" class="custom-control-input" id="sourceOfWealthSelect6" value="Gift" required="">
<label class="custom-control-label text-muted" for="sourceOfWealthSelect6">Obsequio</label>
</div>
<div class="custom-control custom-checkbox ml-5">
<input type="checkbox" name="source_of_wealth[selected][]" class="custom-control-input" id="sourceOfWealthSelect7" value="Lotteries" required="">
<label class="custom-control-label text-muted" for="sourceOfWealthSelect7">Loterías</label>
</div>
<div class="custom-control custom-checkbox ml-5">
<input type="checkbox" name="source_of_wealth[selected][]" class="custom-control-input" id="sourceOfWealthSelect8" value="Other income" required="">
<label class="custom-control-label text-muted" for="sourceOfWealthSelect8">Otro ingreso</label>
</div>
</div>
<div class="col-md-12 spaceFields pt-3">
<label class="control-label text-muted ml-3"><span class="text-primary">*</span>Declaración</label>
<div class="custom-control custom-checkbox ml-5">
<input type="checkbox" name="source_of_wealth[declaration]" class="custom-control-input" id="sourceOfWealthDeclaration" value="I/We declare as an authorized signatory for the Applicant" required="">
<label class="custom-control-label text-muted" for="sourceOfWealthDeclaration">Yo/Nosotros declaro (como firmante autorizado para la aplicación) que la información suministrada en este formulario es de mi conocimiento, precisa y completa.
Además confirmo que mis fondos son de recursos legítimos como se indica arriba y que enviaré la evidencia necesaria de los recursos de mis fondos como es requerido.*</label>
</div>
</div>
<div class="col-md-12 spaceFields mt-4">
<label class="control-label text-muted ml-3"><span class="text-primary">*</span> ¿Tiene alguna conexión con bancarotas?:</label>
<div class="mx-5">
<div class="custom-control custom-radio custom-control-inline">
<input type="radio" id="bunkrupciesS" name="source_of_wealth[bankrupcies]" class="custom-control-input" value="Yes" required="">
<label class="custom-control-label" for="bunkrupciesS">Sí</label>
</div>
<div class="custom-control custom-radio custom-control-inline">
<input type="radio" id="bunkrupciesN" name="source_of_wealth[bankrupcies]" class="custom-control-input" value="No" required="">
<label class="custom-control-label" for="bunkrupciesN">No</label>
</div>
</div>
</div>
<div class="col-md-12 spaceFields mt-2" id="bankruptciesConnected" style="display:none;">
<fieldset class="input textarea" style="height: 100%;">
<textarea style="padding: 4px;" type="text" name="source_of_wealth[what_bankrupcies]" rows="3" class="form-control" placeholder="¿Con qué bancarotas tiene conexión?:"></textarea>
<label class="control-label" for="source_of_wealth[what_bunkrupcies]"><span class="text-primary">*</span>¿Con qué bancarotas tiene conexión?:</label>
</fieldset>
</div>
</div>
<!--end Declaration of Source of Wealth-->
<!--investment experience information-->
<div class="row fieldContainer">
<legend class="col-md-12">Experiencia en Inversiones y Trading<br>
<span class="expText">Por favor, marque a continuación lo que describa mejor su experiencia en inversión:(Si no tiene experiencia invirtiendo antes, por favor "Divulgación de Riesgo Suplementaria")</span>
</legend>
</div>
<div class="row fieldContainer">
<div class="col-md-12"> <label>On-Exchange Securities</label> </div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="onExchangeYears">Años de Experiencia</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="trading_experience[on_exchange][years]" tabindex="-98">
<option value="None">Ninguno</option>
<option value="0 - 2 Years">0 - 2 Años</option>
<option value="2 - 5 Years">2 - 5 Años</option>
<option value="5 - 10 Years">5 - 10 Años</option>
<option value="More than 10 Years">Más de 10 Años</option>
</select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="button" title="Ninguno">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Ninguno</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="onExchangeTradingVolume">Volumen de Operación</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="trading_experience[on_exchange][volume]" tabindex="-98">
<option value="None">Ninguno</option>
<option value="$0 – $50,000">$0 – $50,000</option>
<option value="$50,001 - $100,000">$50,001 - $100,000</option>
<option value="$100,001 - $500,000">$100,001 - $500,000</option>
<option value="$500,000 or more">$500,000 o más</option>
</select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="button" title="Ninguno">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Ninguno</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="onExchangeFrequency">Frecuencia de Operación</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="trading_experience[on_exchange][frequency]" tabindex="-98">
<option value="None">Ninguno</option>
<option value="Daily">Diario</option>
<option value="Weekly">Semanal</option>
<option value="Monthly">Mensual</option>
<option value="Quarterly">Trimestral</option>
<option value="Semi-annually">Semestral</option>
</select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="button" title="Ninguno">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Ninguno</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
</div>
<div class="row fieldContainer">
<div class="col-md-12"> <label>Leverage FX, CFD's y Metales Preciosos</label> </div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="leverageYears">Años de Experiencia</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="trading_experience[leverage][years]" tabindex="-98">
<option value="None">Ninguno</option>
<option value="0 - 2 Years">0 - 2 Años</option>
<option value="2 - 5 Years">2 - 5 Años</option>
<option value="5 - 10 Years">5 - 10 Años</option>
<option value="More than 10 Years">Más de 10 Años</option>
</select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="button" title="Ninguno">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Ninguno</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="leverageTradingVolume">Volumen de Operación</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="trading_experience[leverage][volume]" tabindex="-98">
<option value="None">Ninguno</option>
<option value="$0 – $50,000">$0 – $50,000</option>
<option value="$50,001 - $100,000">$50,001 - $100,000</option>
<option value="$100,001 - $500,000">$100,001 - $500,000</option>
<option value="$500,000 or more">$500,000 o más</option>
</select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="button" title="Ninguno">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Ninguno</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="leverageFrequency">Frecuencia de Operación</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="trading_experience[leverage][frequency]" tabindex="-98">
<option value="None">Ninguno</option>
<option value="Daily">Diario</option>
<option value="Weekly">Semanal</option>
<option value="Monthly">Mensual</option>
<option value="Quarterly">Trimestral</option>
<option value="Semi-annually">Semestral</option>
</select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="button" title="Ninguno">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Ninguno</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
</div>
<div class="row fieldContainer">
<div class="col-md-12"> <label>Commodities</label> </div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="commoditiesYears">Años de Experiencia</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="trading_experience[commodities][years]" tabindex="-98">
<option value="None">Ninguno</option>
<option value="0 - 2 Years">0 - 2 Años</option>
<option value="2 - 5 Years">2 - 5 Años</option>
<option value="5 - 10 Years">5 - 10 Años</option>
<option value="More than 10 Years">Más de 10 Años</option>
</select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="button" title="Ninguno">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Ninguno</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="commoditiesTradingVolume">Volumen de Operación</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="trading_experience[commodities][volume]" tabindex="-98">
<option value="None">Ninguno</option>
<option value="$0 – $50,000">$0 – $50,000</option>
<option value="$50,001 - $100,000">$50,001 - $100,000</option>
<option value="$100,001 - $500,000">$100,001 - $500,000</option>
<option value="$500,000 or more">$500,000 o más</option>
</select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="button" title="Ninguno">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Ninguno</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="commoditiesFrequency">Frecuencia de Operación</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="trading_experience[commodities][frequency]" tabindex="-98">
<option value="None">Ninguno</option>
<option value="Daily">Diario</option>
<option value="Weekly">Semanal</option>
<option value="Monthly">Mensual</option>
<option value="Quarterly">Trimestral</option>
<option value="Semi-annually">Semestral</option>
</select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="button" title="Ninguno">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Ninguno</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
</div>
<div class="row fieldContainer">
<div class="col-md-12"> <label>Futuros</label> </div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="futuresYears">Años de Experiencia</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="trading_experience[futures][years]" tabindex="-98">
<option value="None">Ninguno</option>
<option value="0 - 2 Years">0 - 2 Años</option>
<option value="2 - 5 Years">2 - 5 Años</option>
<option value="5 - 10 Years">5 - 10 Años</option>
<option value="More than 10 Years">Más de 10 Años</option>
</select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="button" title="Ninguno">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Ninguno</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="futuresTradingVolume">Volumen de Operación</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="trading_experience[futures][volume]" tabindex="-98">
<option value="None">Ninguno</option>
<option value="$0 – $50,000">$0 – $50,000</option>
<option value="$50,001 - $100,000">$50,001 - $100,000</option>
<option value="$100,001 - $500,000">$100,001 - $500,000</option>
<option value="$500,000 or more">$500,000 o más</option>
</select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="button" title="Ninguno">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Ninguno</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="futuresFrequency">Frecuencia de Operación</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="trading_experience[futures][frequency]" tabindex="-98">
<option value="None">Ninguno</option>
<option value="Daily">Diario</option>
<option value="Weekly">Semanal</option>
<option value="Monthly">Mensual</option>
<option value="Quarterly">Trimestral</option>
<option value="Semi-annually">Semestral</option>
</select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="button" title="Ninguno">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Ninguno</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
</div>
<div class="row fieldContainer">
<div class="col-md-12"> <label>Opciones</label> </div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="optionsYears">Años de Experiencia</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="trading_experience[options][years]" tabindex="-98">
<option value="None">Ninguno</option>
<option value="0 - 2 Years">0 - 2 Años</option>
<option value="2 - 5 Years">2 - 5 Años</option>
<option value="5 - 10 Years">5 - 10 Años</option>
<option value="More than 10 Years">Más de 10 Años</option>
</select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="button" title="Ninguno">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Ninguno</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="optionsTradingVolume">Volumen de Operación</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="trading_experience[options][volume]" tabindex="-98">
<option value="None">Ninguno</option>
<option value="$0 – $50,000">$0 – $50,000</option>
<option value="$50,001 - $100,000">$50,001 - $100,000</option>
<option value="$100,001 - $500,000">$100,001 - $500,000</option>
<option value="$500,000 or more">$500,000 o más</option>
</select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="button" title="Ninguno">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Ninguno</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="optionsFrequency">Frecuencia de Operación</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="trading_experience[options][frequency]" tabindex="-98">
<option value="None">Ninguno</option>
<option value="Daily">Diario</option>
<option value="Weekly">Semanal</option>
<option value="Monthly">Mensual</option>
<option value="Quarterly">Trimestral</option>
<option value="Semi-annually">Semestral</option>
</select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="button" title="Ninguno">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Ninguno</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
</div>
<div class="row fieldContainer">
<div class="col-md-12"> <label>Fondos de Inversión</label> </div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="mutualFundsYears">Años de Experiencia</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="trading_experience[mutual_funds][years]" tabindex="-98">
<option value="None">Ninguno</option>
<option value="0 - 2 Years">0 - 2 Años</option>
<option value="2 - 5 Years">2 - 5 Años</option>
<option value="5 - 10 Years">5 - 10 Años</option>
<option value="More than 10 Years">Más de 10 Años</option>
</select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="button" title="Ninguno">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Ninguno</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="mutualFundsTradingVolume">Volumen de Operación</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="trading_experience[mutual_funds][volume]" tabindex="-98">
<option value="None">Ninguno</option>
<option value="$0 – $50,000">$0 – $50,000</option>
<option value="$50,001 - $100,000">$50,001 - $100,000</option>
<option value="$100,001 - $500,000">$100,001 - $500,000</option>
<option value="$500,000 or more">$500,000 o más</option>
</select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="button" title="Ninguno">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Ninguno</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-4 spaceFields">
<fieldset class="input">
<label class="control-label" for="mutualFundsFrequency">Frecuencia de Operación</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="trading_experience[mutual_funds][frequency]" tabindex="-98">
<option value="None">Ninguno</option>
<option value="Daily">Diario</option>
<option value="Weekly">Semanal</option>
<option value="Monthly">Mensual</option>
<option value="Quarterly">Trimestral</option>
<option value="Semi-annually">Semestral</option>
</select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="button" title="Ninguno">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Ninguno</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
</div>
<!--end investment experience information-->
<!--extra information-->
<div class="row fieldContainer">
<legend class="col-md-12">Información Adicional</legend>
<div class="col-md-6">
<fieldset class="input">
<label class="control-label" for="volumeAnticipated"><span class="text-primary">*</span>Cantidad de depósitos anticipados en un año base:</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="extra_information[anticipated_volume]" required="" tabindex="-98">
<option value="" selected="" disabled="">Por favor seleccione</option>
<option value="$0 - $25,000">$0 - $25,000</option>
<option value="$25,000 - $100,000">$25,000 - $100,000</option>
<option value="$100,000 - $250,000">$100,000 - $250,000</option>
<option value="$250,000 - 1 Million">$250,000 - 1 Millón de dólares</option>
<option value="Over 1 Million">Más de 1 Millón de dólares</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="button" title="Por favor seleccione">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Por favor seleccione</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
<div class="col-md-6">
<fieldset class="input">
<label class="control-label" for="purposeAccount"><span class="text-primary">*</span>Propósito de la Cuenta</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="extra_information[account_purpose]" required="" tabindex="-98">
<option value="" selected="" disabled="">Por favor seleccione</option>
<option value="Hedging">Cobertura</option>
<option value="Speculation">Especulación</option>
<option value="Proprietary trading">Operaciones por cuenta propia</option>
<option value="Other">Otro</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="button" title="Por favor seleccione">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Por favor seleccione</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
</div>
<div id="OtherPurposeAccount" style="display:none;">
<div class="row fieldContainer">
<div class="col-md-12 spaceFields">
<fieldset class="input">
<input type="text" name="extra_information[other_account_purpose]" class="form-control" placeholder="¿Cuál es el Propósito de la Cuenta?">
<label class="control-label" for="otherPurposeAccount"><span class="text-primary">*</span>¿Cuál es el Propósito de la Cuenta?</label>
</fieldset>
</div>
</div>
</div>
<div class="row fieldContainer">
<div class="col-md-12 spaceFields">
<label class="control-label text-muted ml-3"><span class="text-primary">*</span> Manejo de la Cuenta</label>
<div class="mx-5">
<div class="custom-control custom-checkbox custom-control-inline">
<input type="checkbox" id="managementAccountX" name="extra_information[account_management][]" class="custom-control-input" value="Self - management" required="">
<label class="custom-control-label" for="managementAccountX">Manejo Propio</label>
</div>
<div class="custom-control custom-checkbox custom-control-inline">
<input type="checkbox" id="managementAccountY" name="extra_information[account_management][]" class="custom-control-input" value="Third party manager" required="">
<label class="custom-control-label" for="managementAccountY">Manejo de un Tercero</label>
</div>
<div class="custom-control custom-checkbox custom-control-inline">
<input type="checkbox" id="managementAccountZ" name="extra_information[account_management][]" class="custom-control-input" value="You act as professional manager (i.e. manages the accounts of others)" required="">
<label class="custom-control-label" for="managementAccountZ">Manejo profesional (usted maneja las cuentas de otros)</label>
</div>
</div>
</div>
</div>
<div id="LimitedPowerOfAttorneyBox" style="display:none">
<div class="row fieldContainer">
<div class="col-md-12">
<div class="attached-file">
<p class="warningParagraph"><a href="https://www.tradeviewlatam.com/files?show&folder=pdfs_forms&file=Power_of_Attorney.pdf" class="text-primary" target="_blank">Por favor, <b>descargue aquí </b></a> el Poder Notarial Limitado y
adjúntelo en el campo de abajo</p>
<fieldset class="input">
<span class="labelFile"><span class="text-primary">*</span>Poder Notarial Limitado</span>
<input type="file" name="form_power_of_attorney" id="form_power_of_attorney" accept=".PNG,.JPG,.png,.jpg,.jpeg,.pdf,.doc,.docx" class="inputfile inputfile-6">
<label for="form_power_of_attorney">
<strong> Seleccione un archivo…… <b style="color:#e0e0e0;">|</b>
</strong>
<span></span>
</label>
</fieldset>
</div>
</div>
</div>
</div>
<div class="row fieldContainer">
<div class="col-md-6">
<fieldset class="input">
<input type="text" name="extra_information[ib_name]" class="form-control" placeholder="Introducing Broker, si aplica">
<label class="control-label" for="ibName">Introducing Broker, si aplica</label>
</fieldset>
</div>
<div class="col-md-6">
<fieldset class="input">
<input type="text" name="extra_information[account_manager_name]" class="form-control" placeholder="Persona de Ventas, si aplica">
<label class="control-label" for="accManager">Persona de Ventas, si aplica</label>
</fieldset>
</div>
</div>
<div class="row fieldContainer">
<div class="col-md-4 spaceFields mt-4">
<label class="control-label text-muted ml-3"><span class="text-primary">*</span>¿Desea tener referidos?:</label>
<div class="mx-5">
<div class="custom-control custom-radio custom-control-inline">
<input type="radio" id="referralsS" name="extra_information[referrals]" class="custom-control-input" value="Si" required="">
<label class="custom-control-label" for="referralsS">Sí</label>
</div>
<div class="custom-control custom-radio custom-control-inline">
<input type="radio" id="referralsN" name="extra_information[referrals]" class="custom-control-input" value="No" required="">
<label class="custom-control-label" for="referralsN">No</label>
</div>
</div>
</div>
</div>
<div class="row fieldContainer referrals" style="display: none;">
<div class="col-md-4 spaceFields">
<fieldset class="input">
<input type="number" name="primary_holder_detail[number_offices]" class="form-control" placeholder="¿Cuántas oficinas tiene?">
<label class="control-label" for="primary_holder_detail[number_offices]"><span class="text-primary">*</span>¿Cuántas oficinas tiene? </label>
</fieldset>
</div>
<div class="col-md-8 spaceFields">
<fieldset class="input">
<input type="text" name="primary_holder_detail[offices_cities]" class="form-control" placeholder="Por favor, indique en que ciudades se encuentran sus oficinas">
<label class="control-label" for="primary_holder_detail[offices_cities]">Por favor, indique en que ciudades se encuentran sus oficinas</label>
</fieldset>
</div>
</div>
<div class="row fieldContainer referrals mt-4" style="display: none;">
<div class="col-md-4 spaceFields mt-4">
<label class="control-label text-muted ml-3"><span class="text-primary">*</span>¿Usted adquiere nuevos clientes constantemente?</label>
<div class="mx-5">
<div class="custom-control custom-radio custom-control-inline">
<input type="radio" id="new_client_acquirementS" name="primary_holder_detail[new_client_acquirement]" class="custom-control-input" value="Si">
<label class="custom-control-label" for="new_client_acquirementS">Sí</label>
</div>
<div class="custom-control custom-radio custom-control-inline">
<input type="radio" id="new_client_acquirementN" name="primary_holder_detail[new_client_acquirement]" class="custom-control-input" value="No">
<label class="custom-control-label" for="new_client_acquirementN">No</label>
</div>
</div>
</div>
<div class="col-md-8 spaceFields" id="primary_holder_detail[promotional_material]" style="display: none;">
<fieldset class="input textarea" style="min-height: 54px;">
<textarea type="text" name="primary_holder_detail[promotional_material]" class="form-control pholder" placeholder="¿Qué tipo de material promocional utiliza? (Volantes impresos, TV/radio, boletines de prensa, correo directo)" rows="3"
style="height: 30px;"></textarea>
<label class="control-label" for="primary_holder_detail[promotional_material]">¿Qué tipo de material promocional utiliza? (Volantes impresos, TV/radio, boletines de prensa, correo directo):</label>
</fieldset>
</div>
</div>
<div class="row fieldContainer referrals" style="display: none;">
<div class="col-md-4 spaceFields mt-4" id="sell_force" style="display: none;">
<label class="control-label text-muted ml-3"><span class="text-primary">*</span>¿Su fuerza de ventas busca negocios en otros países?:</label>
<div class="mx-5">
<div class="custom-control custom-radio custom-control-inline">
<input type="radio" id="sell_force_overseasS" name="primary_holder_detail[sell_force_overseas]" class="custom-control-input" value="Si">
<label class="custom-control-label" for="sell_force_overseasS">Sí</label>
</div>
<div class="custom-control custom-radio custom-control-inline">
<input type="radio" id="sell_force_overseasN" name="primary_holder_detail[sell_force_overseas]" class="custom-control-input" value="No">
<label class="custom-control-label" for="sell_force_overseasN">No</label>
</div>
</div>
</div>
<div class="col-md-4 spaceFields" id="primary_holder_detail[sell_force_country]" style="display: none;">
<fieldset class="input textarea" style="min-height: 54px;">
<textarea type="text" name="primary_holder_detail[sell_force_country]" class="form-control pholder" placeholder="¿Qué países?" rows="3" style="height: 30px;"></textarea>
<label class="control-label" for="primary_holder_detail[sell_force_country]"><span class="text-primary">*</span>¿Qué países?:</label>
</fieldset>
</div>
</div>
<div class="row fieldContainer referrals mt-4" style="display: none;">
<div class="col-md-6 spaceFields">
<label class="control-label text-muted ml-3"><span class="text-primary">*</span>¿Ha recibido quejas de algún cliente relacionadas con trading excesivo en cuentas discrecionales?:</label>
<div class="mx-5">
<div class="custom-control custom-radio custom-control-inline">
<input type="radio" id="complaints_trading_accountS" name="primary_holder_detail[number_complaints]" class="custom-control-input" value="Si">
<label class="custom-control-label" for="complaints_trading_accountS">Sí</label>
</div>
<div class="custom-control custom-radio custom-control-inline">
<input type="radio" id="complaints_trading_accountN" name="primary_holder_detail[number_complaints]" class="custom-control-input" value="No">
<label class="custom-control-label" for="complaints_trading_accountN">No</label>
</div>
</div>
</div>
<div class="col-md-6 spaceFields">
<fieldset class="input textarea" style="min-height: 54px;">
<textarea type="text" name="primary_holder_detail[which_complaints]" class="form-control pholder" placeholder="Si ha recibido alguna, ¿Qué clase de quejas recibió (Cuál era la queja de cada cliente)?" rows="3"
style="height: 30px;"></textarea>
<label class="control-label" for="primary_holder_detail[which_complaints]"><span class="text-primary">*</span>Si ha recibido alguna, ¿Qué clase de quejas recibió (Cuál era la queja de cada cliente)?:</label>
</fieldset>
</div>
</div>
<div class="row fieldContainer referrals mt-4" style="display: none;">
<div class="col-md-4 spaceFields mt-4">
<fieldset class="input">
<input type="number" name="primary_holder_detail[complaints_trading_account]" class="form-control" placeholder="¿Cuántas quejas ha recibido en los últimos dos años?">
<label class="control-label" for="primary_holder_detail[complaints_trading_account]"><span class="text-primary">*</span>¿Cuántas quejas ha recibido en los últimos dos años?:</label>
</fieldset>
</div>
<div class="col-md-8 spaceFields mt-4">
<label class="control-label text-muted ml-3"><span class="text-primary">*</span>¿Alguna queja acerca de operaciones no autorizadas?:</label>
<div class="mx-5">
<div class="custom-control custom-radio custom-control-inline">
<input type="radio" id="complaints_unauthorised_operationS" name="primary_holder_detail[complaints_unauthorised_operation]" class="custom-control-input" value="Si">
<label class="custom-control-label" for="complaints_unauthorised_operationS">Sí</label>
</div>
<div class="custom-control custom-radio custom-control-inline">
<input type="radio" id="complaints_unauthorised_operationN" name="primary_holder_detail[complaints_unauthorised_operation]" class="custom-control-input" value="No">
<label class="custom-control-label" for="complaints_unauthorised_operationN">No</label>
</div>
</div>
</div>
</div>
<div class="row fieldContainer referrals mt-4" style="display: none;">
<div class="col-md-12 spaceFields">
<fieldset class="input textarea">
<textarea type="text" name="primary_holder_detail[which_complaints]" class="form-control pholder" placeholder="" rows="3" style="height: 30px;"></textarea>
<label class="control-label largest_textarea" for="primary_holder_detail[which_complaints]"><span class="text-primary">*</span>Describa brevemente cualquier acción disciplinaria tomada por las agencias regulatorias (si no aplica coloque
N/A):</label>
</fieldset>
</div>
</div>
<!--end extra information-->
<!--Upload Documents-->
<div class="row fieldContainer">
<legend class="col-md-12">Carga de Archivos<br>
<span class="expText">Por favor cargue los siguientes documentos</span> <br>
</legend>
<!-- Modal -->
<div class="modal fade" id="instructionsModal" tabindex="-1" role="dialog" aria-labelledby="instructionsModalLabel">
<div class="modal-dialog" role="document">
<div class="modal-content">
<div class="modal-header">
<button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button>
</div>
<div class="modal-body">
<img src="https://www.tradeviewlatam.com/assets/img/forms/Tvf-documents-capture-format-en.jpg" class="img-fluid" alt="Tvf documents capture">
</div>
<div class="modal-footer">
<button type="button" class="btn btn-default" data-dismiss="modal">Cerrar</button>
</div>
</div>
</div>
</div>
<!-- End Modal -->
<!-- Type of Document -->
<div class="col-md-6 spaceFields">
<div class="attached-file">
<fieldset class="input">
<label class="control-label" for="country" style="padding: 0px;border-bottom: 0px solid #afafaf;"><span class="text-primary">*</span>Tipo de Doc:</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="backend[document_type]" required="" tabindex="-98">
<option value="" disabled="" selected="">Por favor seleccione</option>
<option value="PP">Pasaporte (Recomendado)</option>
<option value="DL">Licencia de Conducción</option>
<option value="ID">Tarjeta de Identificación</option>
<option value="RP">Permiso de Residencia</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="button" title="Por favor seleccione">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Por favor seleccione</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
</div>
<!-- End Type of Document -->
<!-- Countyr of Document -->
<div class="col-md-6">
<div class="attached-file">
<fieldset class="input">
<label class="control-label" for="country" style="padding: 0px;border-bottom: 0px solid #afafaf;"><span class="text-primary">*</span>País de Emisión:</label>
<div class="dropdown bootstrap-select form-control"><select class="form-control selectpicker" name="backend[document_country]" data-size="10" data-live-search="true" required="" tabindex="-98">
<option value="" selected="" disabled="">País de Emisión:</option>
<option value="AF">Afghanistan</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AG">Antigua & Deps</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia</option>
<option value="BA">Bosnia Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BR">Brazil</option>
<option value="VG">British Virgin Islands</option>
<option value="BN">Brunei</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina</option>
<option value="BI">Burundi</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</option>
<option value="CV">Cape Verde</option>
<option value="KY">Cayman Island</option>
<option value="CF">Central African Rep</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CO">Colombia</option>
<option value="CN">China</option>
<option value="KM">Comoros</option>
<option value="CG">Congo</option>
<option value="CD">Congo (Democratic Rep)</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czech Republic</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="TL">East Timor</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="ET">Ethiopia</option>
<option value="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FR">France</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana</option>
<option value="GR">Greece</option>
<option value="GD">Grenada</option>
<option value="GT">Guatemala</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HN">Honduras</option>
<option value="HK">Hong-Kong</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IR">Iran</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland (Republic)</option>
<option value="IL">Israel</option>
<option value="IT">Italy</option>
<option value="CI">Ivory Coast</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KP">Korea North</option>
<option value="KR">Korea South</option>
<option value="XK">Kosovo</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Laos</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MK">Macedonia</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MH">Marshall Islands</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesia</option>
<option value="MD">Moldova</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="ME">Montenegro</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="MM">Myanmar, (Burma)</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">Palestinian Territory</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="QA">Qatar</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="KN">St Kitts & Nevis</option>
<option value="LC">St Lucia</option>
<option value="VC">Saint Vincent & the Grenadines the Grenadines</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome & Principe</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="RS">Serbia</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SK">Slovakia</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="SS">South Sudan</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SZ">Swaziland</option>
<option value="SE">Sweden</option>
<option value="XA">Switzerland</option>
<option value="SY">Syria</option>
<option value="TW">Taiwan</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania</option>
<option value="TH">Thailand</option>
<option value="TG">Togo</option>
<option value="TO">Tonga</option>
<option value="TT">Trinidad & Tobago</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="TM">Turkmenistan</option>
<option value="TV">Tuvalu</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom</option>
<option value="US">United States</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VA">Vatican City</option>
<option value="VE">Venezuela</option>
<option value="VN">Vietnam</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="button" title="País de Emisión:">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">País de Emisión:</div>
</div>
</div>
</button>
<div class="dropdown-menu " role="combobox">
<div class="bs-searchbox"><input type="text" class="form-control" autocomplete="off" role="textbox" aria-label="Search"></div>
<div class="inner show" role="listbox" aria-expanded="false" tabindex="-1">
<ul class="dropdown-menu inner show"></ul>
</div>
</div>
</div>
</fieldset>
</div>
</div>
<!-- End Countyr of Document -->
</div>
<!-- Passport Upload -->
<div class="row fieldContainer" id="docPassport" style="display: none;background: #f2f2f2">
<div class="col-md-12">
<span
class="expText"><a href="" data-toggle="modal" data-target="#instructionsModal"><span class="interrogacion">?</span> <span style="color: #ff0000;">Importante:</span><span style="color: #222"> Lea las instrucciones para la subida de archivos </span></a></span>
<!-- Button trigger modal -->
</div>
<div class="col-md-6">
<div class="attached-file">
<fieldset class="input">
<span class="labelFile"><span class="text-primary">*</span> Pasaporte <small>(ID gubernamental)</small></span>
<input type="file" name="doc_id_passport" id="doc_id_passport" accept=".PNG,.JPG,.png,.jpg,.jpeg" class="inputfile inputfile-6">
<label for="doc_id_passport">
<strong> Seleccione un archivo…… <b style="color:#e0e0e0;">|</b>
</strong>
<span></span>
</label>
</fieldset>
</div>
</div>
<div class="col-md-6">
<img src="https://www.tradeviewlatam.com/assets/img/forms/PASSPORT.png" class="img-fluid" alt="Pasaporte">
</div>
</div>
<!-- End Passport Upload -->
<!-- Driver License Upload -->
<div class="row fieldContainer" id="docDriversLicense" style="display: none;background: #f2f2f2">
<div class="col-md-12 pad-15">
<span
class="expText"><a href="" data-toggle="modal" data-target="#instructionsModal"><span class="interrogacion">?</span> <span style="color: #ff0000;">Importante:</span><span style="color: #222"> Lea las instrucciones para la subida de archivos</span></a></span>
<!-- Button trigger modal -->
</div>
<div class="col-md-4">
<div class="attached-file">
<fieldset class="input">
<span class="labelFile"><span class="text-primary">*</span> Licencia de Conducción Cara Frontal<small>(ID gubernamental)</small></span>
<input type="file" name="doc_id_driver_license" id="doc_id_driver_license" accept=".PNG,.JPG,.png,.jpg,.jpeg" class="inputfile inputfile-6">
<label for="doc_id_driver_license">
<strong> Seleccione un archivo…… <b style="color:#e0e0e0;">|</b>
</strong>
<span></span>
</label>
</fieldset>
</div>
</div>
<div class="col-md-2">
<img src="https://www.tradeviewlatam.com/assets/img/forms/DRIVER-LICENSE.png" class="img-fluid center-block" alt="DRIVER-LICENSE">
</div>
<div class="col-md-4">
<div class="attached-file">
<fieldset class="input">
<span class="labelFile"><span class="text-primary">*</span> Licencia de Conducción Cara Trasera<small>(ID gubernamental)</small></span>
<input type="file" name="doc_id_back_driver_license" id="doc_id_back_driver_license" accept=".PNG,.JPG,.png,.jpg,.jpeg" class="inputfile inputfile-6">
<label for="doc_id_back_driver_license">
<strong> Seleccione un archivo…… <b style="color:#e0e0e0;">|</b>
</strong>
<span></span>
</label>
</fieldset>
</div>
</div>
<div class="col-md-2">
<img src="https://www.tradeviewlatam.com/assets/img/forms/REVERSE-DRIVER-LICENSE.png" class="img-fluid center-block" alt="DRIVER-LICENSE">
</div>
</div>
<!-- End Driver License Upload -->
<!-- Goverment ID Upload -->
<div class="row fieldContainer" id="docNationalID" style="display: none; background: #f2f2f2">
<div class="col-md-12 pad-15">
<span
class="expText"><a href="" data-toggle="modal" data-target="#instructionsModal"><span class="interrogacion">?</span> <span style="color: #ff0000;">Importante:</span><span style="color: #222"> Lea las instrucciones para la subida de archivos</span></a></span>
<!-- Button trigger modal -->
</div>
<div class="col-md-4">
<div class="attached-file">
<fieldset class="input">
<span class="labelFile"><span class="text-primary">*</span>ID Nacional Cara Frontal <small>(ID gubernamental)</small></span>
<input type="file" name="doc_id_identity_card" id="doc_id_identity_card" accept=".PNG,.JPG,.png,.jpg,.jpeg" class="inputfile inputfile-6">
<label for="doc_id_identity_card">
<strong> Seleccione un archivo…… <b style="color:#e0e0e0;">|</b>
</strong>
<span></span>
</label>
</fieldset>
</div>
</div>
<div class="col-md-2">
<img src="https://www.tradeviewlatam.com/assets/img/forms/ID-CARD.png" class="img-fluid center-block" alt="">
</div>
<div class="col-md-4">
<div class="attached-file">
<fieldset class="input">
<span class="labelFile"><span class="text-primary">*</span> ID Nacional Cara Trasera <small>(ID gubernamental)</small></span>
<input type="file" name="doc_id_back_identity_card" id="doc_id_back_identity_card" accept=".PNG,.JPG,.png,.jpg,.jpeg" class="inputfile inputfile-6">
<label for="doc_id_back_identity_card">
<strong> Seleccione un archivo…… <b style="color:#e0e0e0;">|</b>
</strong>
<span></span>
</label>
</fieldset>
</div>
</div>
<div class="col-md-2">
<img src="https://www.tradeviewlatam.com/assets/img/forms/REVERSE-ID-CARD.png" class="img-fluid center-block" alt="">
</div>
</div>
<!-- End Goverment ID Upload -->
<!-- Residence Permit Upload -->
<div class="row fieldContainer" id="docResidencePermit" style="display: none;background: #f2f2f2">
<div class="col-md-12 pad-15">
<span
class="expText"><a href="" data-toggle="modal" data-target="#instructionsModal"><span class="interrogacion">?</span> <span style="color: #ff0000;">Importante:</span><span style="color: #222"> Lea las instrucciones para la subida de archivos</span></a></span>
<!-- Button trigger modal -->
</div>
<div class="col-md-6">
<div class="attached-file">
<fieldset class="input">
<span class="labelFile"><span class="text-primary">*</span> Permiso de Residencia <small>(ID gubernamental)</small></span>
<input type="file" name="doc_id_residence_permit" id="doc_id_residence_permit" accept=".PNG,.JPG,.png,.jpg,.jpeg" class="inputfile inputfile-6">
<label for="doc_id_residence_permit">
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<div class="col-md-6">
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<!-- End Residence Permit Upload -->
<!-- Proof of Address Upload -->
<div class="row fieldContainer">
<div class="col-md-6" id="PruebaDir">
<div class="attached-file">
<fieldset class="input">
<span class="labelFile"><span class="text-primary">*</span>Prueba de Dirección (Factura de Servicios / Extracto Bancario)</span>
<input type="file" name="doc_proof_of_address" id="doc_proof_of_address" accept=".PNG,.JPG,.png,.jpg,.jpeg,.pdf,.doc,.docx" class="inputfile inputfile-6" required="">
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<strong> Seleccione un archivo…… <b style="color:#e0e0e0;">|</b>
</strong>
<span></span>
</label>
</fieldset>
</div>
</div>
<!-- End Proof of Address Upload -->
</div>
<div class="row fieldContainer p-0">
<legend class="col-md-12" id="legendEquities" style="display:none;"><small>Documentos para cuenta equities</small></legend>
<!-- Form W-8BEN Upload -->
<div class="col-md-6 mt-2" id="form_fw8ben" style="display:none;">
<div class="attached-file">
<p class="warningParagraph"><a href="https://www.tradeviewlatam.com/files?show&folder=pdfs_forms&file=fw8ben.pdf" class="text-primary" target="_blank">Por favor, <b>descargue aquí</b></a> el formulario W-8BEN y adjúntelo en el campo
de abajo</p>
<fieldset class="input">
<span class="labelFile"><span class="text-primary">*</span>Formulario W-8BEN:</span>
<input type="file" name="form_w8ben" id="form_w8ben" accept=".PNG,.JPG,.png,.jpg,.jpeg,.pdf,.doc,.docx" class="inputfile inputfile-6">
<label for="form_w8ben">
<strong> Seleccione un archivo…… <b style="color:#e0e0e0;">|</b>
</strong>
<span></span>
</label>
</fieldset>
</div>
</div>
<!-- end Form W-8BEN Upload -->
<!-- Equities Corporate Signature Pages -->
<div class="col-md-6 mt-2" id="form_fCorporateSignaturePages" style="display:none;">
<div class="attached-file">
<p class="warningParagraph"><a href="https://www.tradeviewlatam.com/files?show&folder=pdfs_forms&file=Corporate-Agreement.pdf" class="text-primary" target="_blank">Por favor, <b>descargue aquí</b></a> el formulario Corporate Signature
Pages y adjúntelo en el campo de abajo/p> </p>
<fieldset class="input">
<span class="labelFile"><span class="text-primary">*</span>Corporate Signature Pages (paquete nuevo):</span>
<input type="file" name="form_corporate_signature" id="form_corporate_signature" accept=".PNG,.JPG,.png,.jpg,.jpeg,.pdf,.doc,.docx" class="inputfile inputfile-6">
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<strong> Seleccione un archivo…… <b style="color:#e0e0e0;">|</b>
</strong>
<span></span>
</label>
</fieldset>
</div>
</div>
<!-- Equities Corporate Signature Pages -->
<!-- Equities Client Agreement Upload -->
<div class="col-md-6 mt-2" id="form_fEquitiesClientAgreement" style="display:none;">
<div class="attached-file">
<p class="warningParagraph"><a href="https://www.tradeviewlatam.com/files?show&folder=pdfs_forms&file=on_exchange_agreement_sp.pdf" class="text-primary" target="_blank">Por favor, <b>descargue aquí</b></a> el formulario Equities
Client Agreement y adjúntelo en el campo de abajo</p>
<fieldset class="input">
<span class="labelFile"><span class="text-primary">*</span>Equities Client Agreement:</span>
<input type="file" name="form_equities_client_agreement" id="form_equities_client_agreement" accept=".PNG,.JPG,.png,.jpg,.jpeg,.pdf,.doc,.docx" class="inputfile inputfile-6">
<label for="form_equities_client_agreement">
<strong> Seleccione un archivo…… <b style="color:#e0e0e0;">|</b>
</strong>
<span></span>
</label>
</fieldset>
</div>
</div>
<!-- Equities Client Agreement Upload -->
<!-- Non-pro-questionaire Upload -->
<div class="col-md-6 mt-2" id="form_fNonProQuestionaire" style="display:none;">
<div class="attached-file">
<p class="warningParagraph"><a href="https://www.tradeviewlatam.com/files?show&folder=pdfs_forms&file=STT-Non-Pro-Questionaire-Fields.pdf" class="text-primary" target="_blank">Por favor, <b>descargue aquí</b></a> el formulario
Non-pro-questionaire y adjúntelo en el campo de abajo</p>
<fieldset class="input">
<span class="labelFile"><span class="text-primary">*</span>Non-pro-questionaire:</span>
<input type="file" name="form_sterling_non_pro_questionaire" id="form_sterling_non_pro_questionaire" accept=".PNG,.JPG,.png,.jpg,.jpeg,.pdf,.doc,.docx" class="inputfile inputfile-6">
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<strong> Seleccione un archivo…… <b style="color:#e0e0e0;">|</b>
</strong>
<span></span>
</label>
</fieldset>
</div>
</div>
<!-- Non-pro-questionaire Upload -->
</div>
<!--End Upload Documents-->
<div class="row mt-4">
<div class="col md-12 bg-well p-4">
<div class="row">
<div class="col md-12">
<div class="row">
<div class="col md-3">
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<div class="col-md-4">
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<div class="col md-3">
<a href="https://www.tradeviewlatam.com/files?show&folder=pdfs_forms&file=ClientAgreementLatam-en.pdf" target="_blank" class="row">
<div class="col-md-4">
<img src="https://www.tradeviewlatam.com/assets/img/icons/pdfIcon.png" class="img-fluid">
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<p class="col-md-8">Acuerdo del Cliente</p>
</a>
</div>
<div class="col md-3">
<a href="https://www.tradeviewlatam.com/files?show&folder=pdfs_forms&file=AdditionalRiskDisclosure-en.pdf" target="_blank" class="row">
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<p class="col-md-8">Divulgación de Riesgo Suplementaria</p>
</a>
</div>
</div>
</div>
</div>
</div>
</div>
<!-- ======== eSignature ======== -->
<div class="row">
<div class="col-sm-12">
<div onselectstart="return false" class="eSignature">
<input id="eSignature" type="text" name="eSignature" value="" required="">
<div id="signature-pad" class="m-signature-pad">
<div class="m-signature-pad--body">
<canvas width="1068" height="213" style="touch-action: none;"></canvas>
</div>
<div class="m-signature-pad--footer">
<div id="eDescription" class="description">Firma del Cliente Autorizado, <br>Firme Arriba</div>
<div class="left">
<button id="clearBTN" type="button" class="btn btnSolutions button clear" data-action="clear">Limpiar</button>
</div>
<div class="right">
<button id="confirmBTN" type="button" class="btn btnSolutions button save" data-action="confirm">Confirmar Firma</button>
</div>
</div>
</div>
</div>
</div>
</div>
<!-- ======== End eSignature ======== -->
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<div class="row">
<div class="col-md-6 px-5">
<div class="checkbox agreement custom-control custom-checkbox ml-5">
<input type="checkbox" name="backend[validate_terms]" class="custom-control-input" id="validateTermsCheck" value="Checked" required="">
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CUENTA INDIVIDUAL
*Seleccione una Plataforma
Plataforma... FX PLATFORMS Tradeview MT4 Innovative Liquidity ConnectorTradeview
MT4 X LeverageTradeview MT5 Innovative Liquidity ConnectorTradeview MT5 X
LeverageTradeview cTraderEQUITY PLATFORMSSterling Trader - USA On-Exchange
EquitiesTradeview LightspeedDAS Trader - On Exchange EquitiesTakionTradeview MT5
EquitiesFuturesOther - API or FIX Integration
Plataforma...
*Tipo de Moneda
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Seleccione una Moneda
Información del Titular de la Cuenta Primaria
*Apellido:
*Primer Nombre:
Segundo Nombre:
*Lugar de Nacimiento
Lugar de Nacimiento AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua &
DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia
HerzegovinaBotswanaBrazilBritish Virgin
IslandsBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCayman
IslandCentral African RepChadChileColombiaChinaComorosCongoCongo (Democratic
Rep)Cook IslandsCosta RicaCroatiaCubaCyprusCzech
RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl
SalvadorEquatorial
GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong-KongHungaryIcelandIndiaIndonesiaIranIraqIreland
(Republic)Isle of ManIsraelItalyIvory
CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea
SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall
IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar,
(Burma)NamibiaNauruNepalNetherlandsNew
ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPalestinian
TerritoryPanamaPapua New
GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussian
FederationRwandaSt Kitts & NevisSt LuciaSaint Vincent & the Grenadines the
GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi
ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon
IslandsSomaliaSouth AfricaSouth SudanSpainSri
LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad
& TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited
KingdomUnited StatesUruguayUzbekistanVanuatuVatican
CityVenezuelaVietnamYemenZambiaZimbabwe
Lugar de Nacimiento
*Día de Nacimiento
Día 01020304050607080910111213141516171819202122232425262728293031
Día
Mes JanFebMarAprMayJunJulAugSepOctNovDec
Mes
Año
20052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920191919181917191619151914191319121911191019091908190719061905
Año
Pasaporte N°
Fecha de Expiración del Pasaporte
Día 01020304050607080910111213141516171819202122232425262728293031
Día
Mes JanFebMarAprMayJunJulAugSepOctNovDec
Mes
Año
202320242025202620272028202920302031203220332034203520362037203820392040204120422043204420452046204720482049205020512052205320542055205620572058205920602061206220632064206520662067206820692070207120722073
Año
*Nacionalidad
Nacionalidad AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua &
DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia
HerzegovinaBotswanaBrazilBritish Virgin
IslandsBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCayman
IslandCentral African RepChadChileColombiaChinaComorosCongoCongo (Democratic
Rep)Cook IslandsCosta RicaCroatiaCubaCyprusCzech
RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl
SalvadorEquatorial
GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong-KongHungaryIcelandIndiaIndonesiaIranIraqIreland
(Republic)Isle of ManIsraelItalyIvory
CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea
SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall
IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar,
(Burma)NamibiaNauruNepalNetherlandsNew
ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPalestinian
TerritoryPanamaPapua New
GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussian
FederationRwandaSt Kitts & NevisSt LuciaSaint Vincent & the Grenadines the
GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi
ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon
IslandsSomaliaSouth AfricaSouth SudanSpainSri
LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad
& TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited
KingdomUnited StatesUruguayUzbekistanVanuatuVatican
CityVenezuelaVietnamYemenZambiaZimbabwe
Nacionalidad
Información de Dirección
*País
País AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua &
DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia
HerzegovinaBotswanaBrazilBritish Virgin
IslandsBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCayman
IslandCentral African RepChadChileColombiaChinaComorosCongoCongo (Democratic
Rep)Cook IslandsCosta RicaCroatiaCubaCyprusCzech
RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl
SalvadorEquatorial
GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong-KongHungaryIcelandIndiaIndonesiaIranIraqIreland
(Republic)Isle of ManIsraelItalyIvory
CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea
SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall
IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar,
(Burma)NamibiaNauruNepalNetherlandsNew
ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPalestinian
TerritoryPanamaPapua New
GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussian
FederationRwandaSt Kitts & NevisSt LuciaSaint Vincent & the Grenadines the
GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi
ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon
IslandsSomaliaSouth AfricaSouth SudanSpainSri
LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad
& TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited
KingdomUnited StatesUruguayUzbekistanVanuatuVatican
CityVenezuelaVietnamYemenZambiaZimbabwe
País
*Provincia
*Provincia
Provincia
北海道青森県岩手県宮城県秋田県山形県福島県茨城県栃木県群馬県埼玉県千葉県東京都神奈川県新潟県富山県福井県石川県山梨県長野県岐阜県静岡県愛知県三重県滋賀県京都府大阪府兵庫県奈良県和歌山県鳥取県島根県岡山県広島県山口県徳島県香川県愛媛県高知県福岡県宮崎県長崎県熊本県鹿児島県佐賀県大分県沖縄県
Provincia
*Ciudad:
*Dirección:
Dirección 2
*Código Postal
*Teléfono
Móvil
*E-mail
*Género
Masculino Femenino Otro
Masculino
*Estado Civil
Soltero(a) Casado(a)
Soltero(a)
Declaración de Ciudadanía o Residencia Estadounidense para propósitos de
impuestos
Por favor marque entre las opciones (a), (b) o (c) y complete de manera
apropiada
* Declaración:
(a) Confirmo que soy un ciudadano o residente estadounidense para propósitos de
impuestos (poseedor de Green Card o residente bajo el test sustancial de
presencia) así como lo es mi número de identificación de pago de impuestos
federal (U.S TIN).
(b) Confirmo que nací en los Estados Unidos (o en territorio estadounidense)
pero ya no soy ciudadano estadounidense puesto que he renunciado voluntariamente
a mi ciudadanía como se evidencia en los documentos adjuntos.
(c) Confirmo que no soy ciudadano o residente estadounidense para propósitos de
impuestos.
Declaración de Residencia Fiscal (Diferente a los Estados Unidos)
Por la presente confirmo que soy, para propósitos de impuestos, residente en los
siguientes países (indique el tipo y número de referencia que aplica en cada
país)
*País
País AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua &
DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia
HerzegovinaBotswanaBrazilBritish Virgin
IslandsBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCayman
IslandCentral African RepChadChileColombiaChinaComorosCongoCongo (Democratic
Rep)Cook IslandsCosta RicaCroatiaCubaCyprusCzech
RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl
SalvadorEquatorial
GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong-KongHungaryIcelandIndiaIndonesiaIranIraqIreland
(Republic)Isle of ManIsraelItalyIvory
CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea
SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall
IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar,
(Burma)NamibiaNauruNepalNetherlandsNew
ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPalestinian
TerritoryPanamaPapua New
GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussian
FederationRwandaSt Kitts & NevisSt LuciaSaint Vincent & the Grenadines the
GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi
ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon
IslandsSomaliaSouth AfricaSouth SudanSpainSri
LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad
& TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited
KingdomUnited StatesUruguayUzbekistanVanuatuVatican
CityVenezuelaVietnamYemenZambiaZimbabwe N/A
País
*Tipo de número de refencia de impuestos:
*Número de Referencia de impuestos:
País
País AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua &
DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia
HerzegovinaBotswanaBrazilBritish Virgin
IslandsBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCayman
IslandCentral African RepChadChileColombiaChinaComorosCongoCongo (Democratic
Rep)Cook IslandsCosta RicaCroatiaCubaCyprusCzech
RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl
SalvadorEquatorial
GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong-KongHungaryIcelandIndiaIndonesiaIranIraqIreland
(Republic)Isle of ManIsraelItalyIvory
CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea
SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall
IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar,
(Burma)NamibiaNauruNepalNetherlandsNew
ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPalestinian
TerritoryPanamaPapua New
GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussian
FederationRwandaSt Kitts & NevisSt LuciaSaint Vincent & the Grenadines the
GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi
ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon
IslandsSomaliaSouth AfricaSouth SudanSpainSri
LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad
& TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited
KingdomUnited StatesUruguayUzbekistanVanuatuVatican
CityVenezuelaVietnamYemenZambiaZimbabwe
País
Tipo de número de refencia de impuestos:
Número de Referencia de impuestos:
País
País AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua &
DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia
HerzegovinaBotswanaBrazilBritish Virgin
IslandsBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCayman
IslandCentral African RepChadChileColombiaChinaComorosCongoCongo (Democratic
Rep)Cook IslandsCosta RicaCroatiaCubaCyprusCzech
RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl
SalvadorEquatorial
GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong-KongHungaryIcelandIndiaIndonesiaIranIraqIreland
(Republic)Isle of ManIsraelItalyIvory
CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea
SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall
IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar,
(Burma)NamibiaNauruNepalNetherlandsNew
ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPalestinian
TerritoryPanamaPapua New
GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussian
FederationRwandaSt Kitts & NevisSt LuciaSaint Vincent & the Grenadines the
GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi
ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon
IslandsSomaliaSouth AfricaSouth SudanSpainSri
LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad
& TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited
KingdomUnited StatesUruguayUzbekistanVanuatuVatican
CityVenezuelaVietnamYemenZambiaZimbabwe
País
Tipo de número de refencia de impuestos:
Número de Referencia de impuestos:
Información de Empleo
* Estado Laboral
Empleado
Independiente
Retirado
Desempleado
* Salario Anual:
Menos de $25,000 Firmar
$25,000 hasta $50,000
$50,000 hasta $100,000
Más de $ 100,000
*Tipo de negocio
*Industria
*Ubicación de la empresa
*Nombre del negocio
Enlace al sitio web de la empresa
*Empleador:
*Naturaleza del Negocio
*Dirección del Empleador
Dirección del Empleador #2
*Ciudad del Empleador
*Provincia / Estado del empleador
*Código Zip / Postal del Empleador
*País del Empleador
(Por favor, suministre la información detallada incluyendo el país de origen.
Frases como "transferido desde otra compañía" o "inversiones" no son
suficientes. Si los recursos son derivados de la venta de un negocio, la
descripción debería indicar el nombre del negocio y las actividades de la
compañía. Si los recursos fueron generados a través de ganancias acumuladas, la
declaración jurada debería incluir información como su empleador, su posición y
el número de años trabajando. Los detalles específicos de la fuente de recursos
introducidos son eseciales para que podamos confirmar que los fondos son legales
desde el origen. Nos reservamos el derecho de solicitar documentación adicional
para dar soporte a esta declaración.)
*Fuente de Recursos
Activos Totales
* Ingresos Totales Anuales
Menos de $25,000 Firmar
$25,000 hasta $50,000
$50,000 hasta $100,000
Más de $ 100,000
* Valor Neto Aproximado
Menos de $25,000 Firmar
$25,000 hasta $50,000
$50,000 hasta $100,000
Más de $ 100,000
* Inversión Anticipada
Menos de $25,000 Firmar
$25,000 hasta $50,000
$50,000 hasta $100,000
Más de $ 100,000
Declaración de Recursos
* Recursos de fondos
Proviene de empleo / profesión
Herencia o Divorcio
Venta de una compañía o sus acciones
Propiedad de una compañía y sus beneficios
Inversiones o ahorros
Renta o venta de una propiedad
Obsequio
Loterías
Otro ingreso
*Declaración
Yo/Nosotros declaro (como firmante autorizado para la aplicación) que la
información suministrada en este formulario es de mi conocimiento, precisa y
completa. Además confirmo que mis fondos son de recursos legítimos como se
indica arriba y que enviaré la evidencia necesaria de los recursos de mis fondos
como es requerido.*
* ¿Tiene alguna conexión con bancarotas?:
Sí
No
*¿Con qué bancarotas tiene conexión?:
Experiencia en Inversiones y Trading
Por favor, marque a continuación lo que describa mejor su experiencia en
inversión:(Si no tiene experiencia invirtiendo antes, por favor "Divulgación de
Riesgo Suplementaria")
On-Exchange Securities
Años de Experiencia
Ninguno0 - 2 Años2 - 5 Años5 - 10 AñosMás de 10 Años
Ninguno
Volumen de Operación
Ninguno$0 – $50,000$50,001 - $100,000$100,001 - $500,000$500,000 o más
Ninguno
Frecuencia de Operación
NingunoDiarioSemanalMensualTrimestralSemestral
Ninguno
Leverage FX, CFD's y Metales Preciosos
Años de Experiencia
Ninguno0 - 2 Años2 - 5 Años5 - 10 AñosMás de 10 Años
Ninguno
Volumen de Operación
Ninguno$0 – $50,000$50,001 - $100,000$100,001 - $500,000$500,000 o más
Ninguno
Frecuencia de Operación
NingunoDiarioSemanalMensualTrimestralSemestral
Ninguno
Commodities
Años de Experiencia
Ninguno0 - 2 Años2 - 5 Años5 - 10 AñosMás de 10 Años
Ninguno
Volumen de Operación
Ninguno$0 – $50,000$50,001 - $100,000$100,001 - $500,000$500,000 o más
Ninguno
Frecuencia de Operación
NingunoDiarioSemanalMensualTrimestralSemestral
Ninguno
Futuros
Años de Experiencia
Ninguno0 - 2 Años2 - 5 Años5 - 10 AñosMás de 10 Años
Ninguno
Volumen de Operación
Ninguno$0 – $50,000$50,001 - $100,000$100,001 - $500,000$500,000 o más
Ninguno
Frecuencia de Operación
NingunoDiarioSemanalMensualTrimestralSemestral
Ninguno
Opciones
Años de Experiencia
Ninguno0 - 2 Años2 - 5 Años5 - 10 AñosMás de 10 Años
Ninguno
Volumen de Operación
Ninguno$0 – $50,000$50,001 - $100,000$100,001 - $500,000$500,000 o más
Ninguno
Frecuencia de Operación
NingunoDiarioSemanalMensualTrimestralSemestral
Ninguno
Fondos de Inversión
Años de Experiencia
Ninguno0 - 2 Años2 - 5 Años5 - 10 AñosMás de 10 Años
Ninguno
Volumen de Operación
Ninguno$0 – $50,000$50,001 - $100,000$100,001 - $500,000$500,000 o más
Ninguno
Frecuencia de Operación
NingunoDiarioSemanalMensualTrimestralSemestral
Ninguno
Información Adicional
*Cantidad de depósitos anticipados en un año base:
Por favor seleccione $0 - $25,000$25,000 - $100,000$100,000 - $250,000$250,000 -
1 Millón de dólaresMás de 1 Millón de dólares
Por favor seleccione
*Propósito de la Cuenta
Por favor seleccione CoberturaEspeculaciónOperaciones por cuenta propiaOtro
Por favor seleccione
*¿Cuál es el Propósito de la Cuenta?
* Manejo de la Cuenta
Manejo Propio
Manejo de un Tercero
Manejo profesional (usted maneja las cuentas de otros)
Por favor, descargue aquí el Poder Notarial Limitado y adjúntelo en el campo de
abajo
*Poder Notarial Limitado Seleccione un archivo…… |
Introducing Broker, si aplica
Persona de Ventas, si aplica
*¿Desea tener referidos?:
Sí
No
*¿Cuántas oficinas tiene?
Por favor, indique en que ciudades se encuentran sus oficinas
*¿Usted adquiere nuevos clientes constantemente?
Sí
No
¿Qué tipo de material promocional utiliza? (Volantes impresos, TV/radio,
boletines de prensa, correo directo):
*¿Su fuerza de ventas busca negocios en otros países?:
Sí
No
*¿Qué países?:
*¿Ha recibido quejas de algún cliente relacionadas con trading excesivo en
cuentas discrecionales?:
Sí
No
*Si ha recibido alguna, ¿Qué clase de quejas recibió (Cuál era la queja de cada
cliente)?:
*¿Cuántas quejas ha recibido en los últimos dos años?:
*¿Alguna queja acerca de operaciones no autorizadas?:
Sí
No
*Describa brevemente cualquier acción disciplinaria tomada por las agencias
regulatorias (si no aplica coloque N/A):
Carga de Archivos
Por favor cargue los siguientes documentos
×
Cerrar
*Tipo de Doc:
Por favor seleccione Pasaporte (Recomendado) Licencia de Conducción Tarjeta de
Identificación Permiso de Residencia
Por favor seleccione
*País de Emisión:
País de Emisión: AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua &
DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia
HerzegovinaBotswanaBrazilBritish Virgin
IslandsBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCayman
IslandCentral African RepChadChileColombiaChinaComorosCongoCongo (Democratic
Rep)Cook IslandsCosta RicaCroatiaCubaCyprusCzech
RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl
SalvadorEquatorial
GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong-KongHungaryIcelandIndiaIndonesiaIranIraqIreland
(Republic)IsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea
NorthKorea
SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall
IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar,
(Burma)NamibiaNauruNepalNetherlandsNew
ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPalestinian
TerritoryPanamaPapua New
GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussian
FederationRwandaSt Kitts & NevisSt LuciaSaint Vincent & the Grenadines the
GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi
ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon
IslandsSomaliaSouth AfricaSouth SudanSpainSri
LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad
& TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited
KingdomUnited StatesUruguayUzbekistanVanuatuVatican
CityVenezuelaVietnamYemenZambiaZimbabwe
País de Emisión:
? Importante: Lea las instrucciones para la subida de archivos
* Pasaporte (ID gubernamental) Seleccione un archivo…… |
? Importante: Lea las instrucciones para la subida de archivos
* Licencia de Conducción Cara Frontal(ID gubernamental) Seleccione un archivo……
|
* Licencia de Conducción Cara Trasera(ID gubernamental) Seleccione un archivo……
|
? Importante: Lea las instrucciones para la subida de archivos
*ID Nacional Cara Frontal (ID gubernamental) Seleccione un archivo…… |
* ID Nacional Cara Trasera (ID gubernamental) Seleccione un archivo…… |
? Importante: Lea las instrucciones para la subida de archivos
* Permiso de Residencia (ID gubernamental) Seleccione un archivo…… |
*Prueba de Dirección (Factura de Servicios / Extracto Bancario) Seleccione un
archivo…… |
Documentos para cuenta equities
Por favor, descargue aquí el formulario W-8BEN y adjúntelo en el campo de abajo
*Formulario W-8BEN: Seleccione un archivo…… |
Por favor, descargue aquí el formulario Corporate Signature Pages y adjúntelo en
el campo de abajo/p>
*Corporate Signature Pages (paquete nuevo): Seleccione un archivo…… |
Por favor, descargue aquí el formulario Equities Client Agreement y adjúntelo en
el campo de abajo
*Equities Client Agreement: Seleccione un archivo…… |
Por favor, descargue aquí el formulario Non-pro-questionaire y adjúntelo en el
campo de abajo
*Non-pro-questionaire: Seleccione un archivo…… |
Firmas Electrónicas
Términos y Condiciones
Acuerdo del Cliente
Divulgación de Riesgo Suplementaria
Firma del Cliente Autorizado,
Firme Arriba
Limpiar
Confirmar Firma
Reconozco que he leído la información relacionada a la firma, sus términos y
condiciones y he entendido totalmente la información suministrada en ésta.
Enviar
INFORMACIÓN DE FIRMA ELECTRÓNICA
×
Cerrar
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Tradeview Financial Markets SAC
Los Mirtos 239 Urb. San Eugenio, Lince, Lima - Perú
Tel. +1-345-945-6271
Existe riesgo en el intercambio de divisas extranjeras y no es asequible para
cualquier persona. Nuestros servicios son compensados a través de la diferencia
entre la oferta y la demanda. Copyright© 2020. Todos los derechos reservados.
Los servicios y productos ofrecidos. no están disponibles dentro de los Estados
Unidos (EE.UU.) y tampoco se ofrecen a personas de Estados Unidos, según se
define bajo la ley de EE.UU. Como tal, si usted es ciudadano o reside en
cualquiera de estos países, cualquier mensaje de correo electrónico recibido no
tiene la intención de servir como una invitación o inducción a nombre de
cualquiera de las entidades antes mencionadas.
Términos y condiciones