Tullett Prebon

1. First name *  
2. Last name *  
3. Business email *    
4. Company name *  
5. Address line 1 *  
6. Address line 2
7. City *  
8. State/County/Province
9. Zip/Postcode *  
10. Country Select Country United States United Kingdom Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic of The Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and The South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe *  
11. Telephone number *  
12. Job title *  
13. Do you trade with Tullett Prebon? select: Yes No *  
14.   
15. Name of TP broker *  
    If not applicable, please enter "None"
16. Traded product(s) *  
    If not applicable, please enter "None"

1. Name of file requested *  
2. Will the data be used by your back office? select: Yes No *  
3. Will the data be used in an application? select: Yes No *    
4. If yes, application name:
5. If yes, application type:
6. Please explain the intended use of this data: *  

NOTICE TO END USER: PLEASE READ CAREFULLY.

End User certifies that:
a) The end of day pricing information ("Information") is used exclusively by traders identified on the Tullett Prebon Broker End of Day Pricing Request Form ("Form") that deal with Tullett Prebon Information Limited's broking affiliates, within the Tullett Prebon group of companies (collectively "Tullett Prebon") and shall not be shared with or distributed to any of End User's middle or back office business areas for any purpose, including for use in connection with any risk, valuation, or any other pricing applications;
b) The Information is used only for the purpose of supporting the activities of the trader identified on the Form with Tullett Prebon and the data is not used for other purposes including without limitation supporting trading with competitor's of Tullett Prebon;
c) Neither End User nor any of its employees or agents will sell, lease, furnish, redistribute, retransmit, or otherwise permit or provide access to the Information or any data created from the Information through manipulation, modification, supplementation, enhancement or combining with other information ("Derivative Works") to any person other than the trader identified on the Form;
d) The Information or any Derivative Works may not be used in any software applications or other systems accessible by any party other than the relevant trader and only where such systems or software are front office systems supporting the trader's activities with Tullett Prebon ; and
e) Neither End User nor any of its employees or agents will use the Information or any Derivative Works in any products or services that the End User or any employees or agents of the End User provides to any third party, including, but not limited to, portfolio valuation, securities valuation and risk evaluation services.

PLEASE NOTE: The Information consists of purely indicative and historic market prices and no warranty that the Information represents or indicates prices at which transactions may be or were effected at any time is given by Tullett Prebon and is solely for the information purposes of wholesale market clients. Any opinion expressed or assumption or forecast made in association with the Information is a reflection of Tullett Prebon’s judgement at the time of compiling the Information and is subject to change without notice. To the fullest extent permitted by law, Tullett Prebon will accept no responsibility or liability for, and cannot and does not warrant or represent, the accuracy, quality, speed, correctness or completeness, frequency of provision, merchantability or fitness for a particular purpose or requirement of the Information, whether arising from the negligence of Tullett Prebon or otherwise, including, without limitation, any liability for economic loss or any indirect or consequential loss or damage including loss of business, opportunity or profits.