|* All fields are required unless stated otherwise.|
|First Name||*||Email Address||*|
All withdrawals will be made to the same name.
|Please provide an active email address to facilitate future payment related correspondences, eg withdrawals, bonuses.|
|Date of Birth||*||/ /||Contact Number||*|
|Username||*||Please provide a valid contact number for future promotion and payment correspondences.|
|Between 5 to 16 character only.||Preferred Currency||*|
Between 8 to 10 character only.