Limited Power Of Attorney Trading Authorization Page 4
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4Interactive Brokers
Power of Attorney – Financial Advisors
Page 4 of 4
Customer’s Signature:
By signing below, I (we) represent that I (we) have read and agree to be bound by all of the terms and
conditions of this Power of Attorney Agreement as set forth above:
_____________________________________________________
Customer’s Signature
_____________________________________________________
Date
_____________________________________________________
Joint Account Holder’s Signature (if any)
_____________________________________________________
Date
Required Proof of Agent’s Identity, Date of Birth and Residential Address
U.S. anti-money laundering laws require Interactive Brokers to verify the: 1) Identity; 2) Date of Birth; and 3)
Residential Address of all persons who are given authority to trade in customer accounts (i.e., the Agent).
Along with this form, please send the following documents to Interactive Brokers in order to verify Agent’s
information:
Document Category
Acceptable Documents
(only one document per category is
required)
Proof of Identity and Date of Birth
Passport
(The document must include the
National Identity Card
Agent's name, date of birth, the
Driver's License
identification number provided above
Alien Identification Card
and the Agent’s photograph)
Proof of Residential Address
Utility Bill
(The document must be less than 6
L ease
months old and clearly state the Agent’s
M ortgage Statement, Deed or other
residential address. Bills for mobile
evidence of ownership of the property
telephone service are not acceptable)
Driver's License (but only if the trader did
not submit a driver's license as proof of
identity)
This form, and the documents described above, may be sent to Interactive Brokers via any of the following
methods:
Fax:
(312) 984-1017
Courier/Overnight Service:
Interactive Brokers
Document Processing Department
209 South LaSalle St.,10th Floor
Chicago, IL 60604
(312) 542-6900
Regular Mail:
Interactive Brokers
(Please allow additional time for
Document Processing Department
processing)
P.O. Box 5544
Chicago, IL 60680-5544
Version 1/24/2005
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