Transfer funds between your FXCM Ltd Trading and Merchant by alicejenny

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                                                  REFERRING BROKER WITHDRAWAL FORM
   
  Please complete the necessary fields below and submit this information via fax to the number noted above, or via e-mail as a scanned image (JPG, GIF,
  DOC, PDF – no password protection please) to our Operations department at admin@fxcm.com. The request will generally be processed within 2 business
  days of receipt. In order to avoid any delays please review your information carefully before submittal. FXCM assumes no responsibility for errors or
  inaccuracies made by the account holder. Requests to transfer funds to third party will not be processed. Please contact us with any questions or concerns.
           Merchant Name           ______________________________                                  Mailing Address        ______________________________
                   Telephone#      ______________________________                                       City, State       ______________________________
               E-mail Address      ______________________________                                          Zip Code       ______________________________
                                                                                                            Country       ______________________________
  If you would like to first transfer funds into your merchant account from your trading account, please complete the transfer portion of this form, then complete
  the withdrawal section. If not, skip the transfer portion and proceed to complete the withdrawal portion.

  □ Transfer funds between your FXCM Ltd. Trading and Merchant Account(s)
  I understand and accept that by signing below, I have requested for funds to be transferred between my FXCM accounts in accordance with FXCM
  compliance and administrative procedures. Available margin must exist in order for funds to be transferred, as removal of funds may result in a margin call. I
  hereby agree to hold FXCM harmless of any and all claims regarding such funds transfer upon proper credit to the below named FXCM account.

      Server                    100K                      U100R6*                MINIREAL              MINIREAL4                 MINIREAL5          □ OTHER**
      Account #                 ________                  ________ ________                            ________                  ________           ________
      Amount                    $___________              $___________           $___________          $___________              $___________       $___________
                          Transfer to Main Merchant Account #                                __________________________
  *LLC Referring Brokers Only
  **Electronic wires are denominated in the currency of the server.


 Method of Withdrawal Requested: (please select one)                                             Total Withdrawal Amount: $ ________________
          Beneficiary Name must be FXCM account holder only. FXCM will not process third party payments.


 □ Bank Wire
                                USD                                       JPY                                 CAD                  Euro       GBP    AUD       NZD
                     Domestic         International           Domestic           International     Domestic      International
                                                                                                    CAD $25
 FXCM US             $25 (US)             $40                ¥0 (Japan)            ¥ 3,000                          CAD $40         € 30      £15   AUD $15   NZD $30
                                                                                                   (CANADA)
                                                                                                    CAD $25
 FXCM UK           $25 (US & UK)          $40                ¥0 (Japan)            ¥ 3,000                          CAD $40         € 30      £15   AUD $15   NZD $30
                                                                                                   (CANADA)

 FXCM AU           $25 (AU & NZ)          $40                    N/A                 N/A             N/A              N/A           € 30      £15   AUD $15   NZD $30

*THE FOLLOWING SECTION IS REQUIRED FOR JPY WIRE REQUESTS ONLY:
          Account Type:      □ Current      □ Savings □ Deposit             □ Other
 Bank Account Holder Name (Katakana):                                           Bank Name:                                       Bank Code:


 Branch Name:                                                                                              Branch Code:




 □ Check via US Postal Mail
               •     FXCM encourages clients to request payment via wire transfer to ensure timely receipt.
               •     There are no administrative fees associated with this withdrawal method.
               •     To ensure the security of this request, FXCM will send a check payment ONLY to the address on file for the account holder.
               •     FXCM LLC (US) checks are issued in USD only. FXCM Ltd (UK) checks are issued in USD, GBP or EUR.

                                                                        Comments, if any: __________________________________________

 Authorized Representative Signature:__________________________________________________
 Print Authorized Representative Name:_________________________________________________
 Today’s Date: M M / D D / Y Y Y Y
                                   For FXCM Holdings, LLC regulatory information visit http://www.fxcm.com/regulation.jsp.
                                                                                For Office Use Only
                   OP                                       TR                                        ACTG                                           MGT



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Forex Capital Markets – Referring Broker Withdrawal Form
16DEC2009

								
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