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<div class="text-center bg-light p-3 border border-bottom-0">
<h5 class="mb-0">Open an Individual Account</h5>
</div>
<form class="reg-form p-4 bg-white border" method="get" action="" id="registrationForm">
<div class="row mb-3">
<div class="col-6 ">
<input class="form-control" type="text" id="first_name" name="first_name" placeholder="First Name"
required />
<span class="help-block" for="last_name"></span>
</div>
<div class="col-6">
<input class="form-control" type="text" id="last_name" name="last_name" placeholder="Last Name" required />
<span class="help-block" for="last_name"></span>
</div>
</div>
<div class="row mb-3">
<div class="col-12">
<input class="form-control" type="text" id="email" name="email" placeholder="Email" required />
<span class="help-block" for="email"></span>
</div>
</div>
<div class="row mb-3">
<div class="col-12">
<select class="form-control form-select" id="country" name="country" required>
<option value="">- Country of Residence -</option>
<option data-prefix="93" value="AF">Afghanistan</option>
<option data-prefix="355" value="AL">Albania</option>
<option data-prefix="213" value="DZ">Algeria</option>
<option data-prefix="1684" value="AS">American Samoa</option>
<option data-prefix="376" value="AD">Andorra</option>
<option data-prefix="244" value="AO">Angola</option>
<option data-prefix="1264" value="AI">Anguilla</option>
<option data-prefix="7151" value="AQ">Antarctica</option>
<option data-prefix="1268" value="AG">Antigua and Barbuda</option>
<option data-prefix="54" value="AR">Argentina</option>
<option data-prefix="374" value="AM">Armenia</option>
<option data-prefix="297" value="AW">Aruba</option>
<option data-prefix="61" value="AU">Australia</option>
<option data-prefix="43" value="AT">Austria</option>
<option data-prefix="994" value="AZ">Azerbaijan</option>
<option data-prefix="1242" value="BS">Bahamas</option>
<option data-prefix="973" value="BH">Bahrain</option>
<option data-prefix="880" value="BD">Bangladesh</option>
<option data-prefix="1246" value="BB">Barbados</option>
<option data-prefix="375" value="BY">Belarus</option>
<option data-prefix="32" value="BE">Belgium</option>
<option data-prefix="501" value="BZ">Belize</option>
<option data-prefix="229" value="BJ">Benin</option>
<option data-prefix="1441" value="BM">Bermuda</option>
<option data-prefix="975" value="BT">Bhutan</option>
<option data-prefix="591" value="BO">Bolivia</option>
<option data-prefix="387" value="BA">Bosnia and Herzegovina</option>
<option data-prefix="267" value="BW">Botswana</option>
<option data-prefix="0" value="BV">Bouvet Island</option>
<option data-prefix="55" value="BR">Brazil</option>
<option data-prefix="246" value="IO">British Indian Ocean Territory</option>
<option data-prefix="673" value="BN">Brunei Darussalam</option>
<option data-prefix="359" value="BG">Bulgaria</option>
<option data-prefix="226" value="BF">Burkina Faso</option>
<option data-prefix="257" value="BI">Burundi</option>
<option data-prefix="855" value="KH">Cambodia</option>
<option data-prefix="237" value="CM">Cameroon</option>
<option data-prefix="1" value="CA">Canada</option>
<option data-prefix="238" value="CV">Cape Verde</option>
<option data-prefix="1345" value="KY">Cayman Islands</option>
<option data-prefix="236" value="CF">Central African Republic</option>
<option data-prefix="235" value="TD">Chad</option>
<option data-prefix="56" value="CL">Chile</option>
<option data-prefix="86" value="CN">China</option>
<option data-prefix="61" value="CX">Christmas Island</option>
<option data-prefix="672" value="CC">Cocos Islands</option>
<option data-prefix="57" value="CO">Colombia</option>
<option data-prefix="269" value="KM">Comoros</option>
<option data-prefix="242" value="CG">Congo</option>
<option data-prefix="242" value="CD">Congo, the Democratic Republic of the</option>
<option data-prefix="682" value="CK">Cook Islands</option>
<option data-prefix="506" value="CR">Costa Rica</option>
<option data-prefix="225" value="CI">Cote DIvoire</option>
<option data-prefix="385" value="HR">Croatia</option>
<option data-prefix="53" value="CU">Cuba</option>
<option data-prefix="357" value="CY">Cyprus</option>
<option data-prefix="420" value="CZ">Czech Republic</option>
<option data-prefix="45" value="DK">Denmark</option>
<option data-prefix="253" value="DJ">Djibouti</option>
<option data-prefix="1767" value="DM">Dominica</option>
<option data-prefix="1809" value="DO">Dominican Republic</option>
<option data-prefix="593" value="EC">Ecuador</option>
<option data-prefix="20" value="EG">Egypt</option>
<option data-prefix="503" value="SV">El Salvador</option>
<option data-prefix="240" value="GQ">Equatorial Guinea</option>
<option data-prefix="291" value="ER">Eritrea</option>
<option data-prefix="372" value="EE">Estonia</option>
<option data-prefix="251" value="ET">Ethiopia</option>
<option data-prefix="500" value="FK">Falkland Islands</option>
<option data-prefix="298" value="FO">Faroe Islands</option>
<option data-prefix="679" value="FJ">Fiji</option>
<option data-prefix="358" value="FI">Finland</option>
<option data-prefix="33" value="FR">France</option>
<option data-prefix="594" value="GF">French Guiana</option>
<option data-prefix="689" value="PF">French Polynesia</option>
<option data-prefix="0" value="TF">French Southern Territories</option>
<option data-prefix="241" value="GA">Gabon</option>
<option data-prefix="220" value="GM">Gambia</option>
<option data-prefix="995" value="GE">Georgia</option>
<option data-prefix="49" value="DE">Germany</option>
<option data-prefix="233" value="GH">Ghana</option>
<option data-prefix="350" value="GI">Gibraltar</option>
<option data-prefix="30" value="GR">Greece</option>
<option data-prefix="299" value="GL">Greenland</option>
<option data-prefix="1473" value="GD">Grenada</option>
<option data-prefix="590" value="GP">Guadeloupe</option>
<option data-prefix="1671" value="GU">Guam</option>
<option data-prefix="502" value="GT">Guatemala</option>
<option data-prefix="224" value="GN">Guinea</option>
<option data-prefix="245" value="GW">Guinea-Bissau</option>
<option data-prefix="592" value="GY">Guyana</option>
<option data-prefix="509" value="HT">Haiti</option>
<option data-prefix="0" value="HM">Heard Island and Mcdonald Islands</option>
<option data-prefix="39" value="VA">Holy See</option>
<option data-prefix="504" value="HN">Honduras</option>
<option data-prefix="852" value="HK">Hong Kong</option>
<option data-prefix="36" value="HU">Hungary</option>
<option data-prefix="354" value="IS">Iceland</option>
<option data-prefix="91" value="IN">India</option>
<option data-prefix="62" value="ID">Indonesia</option>
<option data-prefix="98" value="IR">Iran</option>
<option data-prefix="964" value="IQ">Iraq</option>
<option data-prefix="964" value="IQA">Iraq Erbil</option>
<option data-prefix="353" value="IE">Ireland</option>
<option data-prefix="972" value="IL">Israel</option>
<option data-prefix="39" value="IT">Italy</option>
<option data-prefix="1876" value="JM">Jamaica</option>
<option data-prefix="81" value="JP">Japan</option>
<option data-prefix="962" value="JO">Jordan</option>
<option data-prefix="7" value="KZ">Kazakhstan</option>
<option data-prefix="254" value="KE">Kenya</option>
<option data-prefix="686" value="KI">Kiribati</option>
<option data-prefix="965" value="KW">Kuwait</option>
<option data-prefix="996" value="KG">Kyrgyzstan</option>
<option data-prefix="856" value="LA">Lao Peoples Democratic Republic</option>
<option data-prefix="371" value="LV">Latvia</option>
<option data-prefix="961" value="LB">Lebanon</option>
<option data-prefix="266" value="LS">Lesotho</option>
<option data-prefix="231" value="LR">Liberia</option>
<option data-prefix="218" value="LY">Libyan Arab Jamahiriya</option>
<option data-prefix="423" value="LI">Liechtenstein</option>
<option data-prefix="370" value="LT">Lithuania</option>
<option data-prefix="352" value="LU">Luxembourg</option>
<option data-prefix="853" value="MO">Macao</option>
<option data-prefix="389" value="MK">Macedonia</option>
<option data-prefix="261" value="MG">Madagascar</option>
<option data-prefix="265" value="MW">Malawi</option>
<option data-prefix="60" value="MY">Malaysia</option>
<option data-prefix="960" value="MV">Maldives</option>
<option data-prefix="223" value="ML">Mali</option>
<option data-prefix="356" value="MT">Malta</option>
<option data-prefix="692" value="MH">Marshall Islands</option>
<option data-prefix="596" value="MQ">Martinique</option>
<option data-prefix="222" value="MR">Mauritania</option>
<option data-prefix="230" value="MU">Mauritius</option>
<option data-prefix="269" value="YT">Mayotte</option>
<option data-prefix="52" value="MX">Mexico</option>
<option data-prefix="691" value="FM">Micronesia</option>
<option data-prefix="373" value="MD">Moldova, Republic of</option>
<option data-prefix="377" value="MC">Monaco</option>
<option data-prefix="976" value="MN">Mongolia</option>
<option data-prefix="1664" value="MS">Montserrat</option>
<option data-prefix="212" value="MA">Morocco</option>
<option data-prefix="258" value="MZ">Mozambique</option>
<option data-prefix="95" value="MM">Myanmar</option>
<option data-prefix="264" value="NA">Namibia</option>
<option data-prefix="674" value="NR">Nauru</option>
<option data-prefix="977" value="NP">Nepal</option>
<option data-prefix="31" value="NL">Netherlands</option>
<option data-prefix="599" value="AN">Netherlands Antilles</option>
<option data-prefix="687" value="NC">New Caledonia</option>
<option data-prefix="64" value="NZ">New Zealand</option>
<option data-prefix="505" value="NI">Nicaragua</option>
<option data-prefix="227" value="NE">Niger</option>
<option data-prefix="234" value="NG">Nigeria</option>
<option data-prefix="683" value="NU">Niue</option>
<option data-prefix="672" value="NF">Norfolk Island</option>
<option data-prefix="1670" value="MP">Northern Mariana Islands</option>
<option data-prefix="47" value="NO">Norway</option>
<option data-prefix="968" value="OM">Oman</option>
<option data-prefix="92" value="PK">Pakistan</option>
<option data-prefix="680" value="PW">Palau</option>
<option data-prefix="970" value="PS">Palestine</option>
<option data-prefix="507" value="PA">Panama</option>
<option data-prefix="675" value="PG">Papua New Guinea</option>
<option data-prefix="595" value="PY">Paraguay</option>
<option data-prefix="51" value="PE">Peru</option>
<option data-prefix="63" value="PH">Philippines</option>
<option data-prefix="0" value="PN">Pitcairn</option>
<option data-prefix="48" value="PL">Poland</option>
<option data-prefix="351" value="PT">Portugal</option>
<option data-prefix="1787" value="PR">Puerto Rico</option>
<option data-prefix="974" value="QA">Qatar</option>
<option data-prefix="850" value="KP">Republic of Korea</option>
<option data-prefix="383" value="KS">Republic of Kosovo</option>
<option data-prefix="262" value="RE">Reunion</option>
<option data-prefix="40" value="RO">Romania</option>
<option data-prefix="70" value="RU">Russian Federation</option>
<option data-prefix="250" value="RW">Rwanda</option>
<option data-prefix="290" value="SH">Saint Helena</option>
<option data-prefix="1869" value="KN">Saint Kitts and Nevis</option>
<option data-prefix="1758" value="LC">Saint Lucia</option>
<option data-prefix="508" value="PM">Saint Pierre and Miquelon</option>
<option data-prefix="1784" value="VC">Saint Vincent and the Grenadines</option>
<option data-prefix="684" value="WS">Samoa</option>
<option data-prefix="378" value="SM">San Marino</option>
<option data-prefix="239" value="ST">Sao Tome and Principe</option>
<option data-prefix="966" value="SA">Saudi Arabia</option>
<option data-prefix="221" value="SN">Senegal</option>
<option data-prefix="381" value="CS">Serbia and Montenegro</option>
<option data-prefix="248" value="SC">Seychelles</option>
<option data-prefix="232" value="SL">Sierra Leone</option>
<option data-prefix="65" value="SG">Singapore</option>
<option data-prefix="421" value="SK">Slovakia</option>
<option data-prefix="386" value="SI">Slovenia</option>
<option data-prefix="677" value="SB">Solomon Islands</option>
<option data-prefix="252" value="SO">Somalia</option>
<option data-prefix="27" value="ZA">South Africa</option>
<option data-prefix="0" value="GS">South Georgia and the South Sandwich Islands</option>
<option data-prefix="34" value="ES">Spain</option>
<option data-prefix="94" value="LK">Sri Lanka</option>
<option data-prefix="249" value="SD">Sudan</option>
<option data-prefix="597" value="SR">Suriname</option>
<option data-prefix="47" value="SJ">Svalbard and Jan Mayen</option>
<option data-prefix="268" value="SZ">Swaziland</option>
<option data-prefix="46" value="SE">Sweden</option>
<option data-prefix="41" value="CH">Switzerland</option>
<option data-prefix="963" value="SY">Syrian Arab Republic</option>
<option data-prefix="886" value="TW">Taiwan, Province of China</option>
<option data-prefix="992" value="TJ">Tajikistan</option>
<option data-prefix="255" value="TZ">Tanzania</option>
<option data-prefix="66" value="TH">Thailand</option>
<option data-prefix="670" value="TL">Timor Leste</option>
<option data-prefix="228" value="TG">Togo</option>
<option data-prefix="690" value="TK">Tokelau</option>
<option data-prefix="676" value="TO">Tonga</option>
<option data-prefix="1868" value="TT">Trinidad and Tobago</option>
<option data-prefix="216" value="TN">Tunisia</option>
<option data-prefix="90" value="TR">Turkey</option>
<option data-prefix="7370" value="TM">Turkmenistan</option>
<option data-prefix="1649" value="TC">Turks and Caicos Islands</option>
<option data-prefix="688" value="TV">Tuvalu</option>
<option data-prefix="256" value="UG">Uganda</option>
<option data-prefix="380" value="UA">Ukraine</option>
<option data-prefix="971" value="AE">United Arab Emirates</option>
<option data-prefix="44" value="GB">United Kingdom</option>
<option data-prefix="1" value="US">United States</option>
<option data-prefix="1" value="UM">United States Minor Outlying Islands</option>
<option data-prefix="598" value="UY">Uruguay</option>
<option data-prefix="998" value="UZ">Uzbekistan</option>
<option data-prefix="678" value="VU">Vanuatu</option>
<option data-prefix="58" value="VE">Venezuela</option>
<option data-prefix="84" value="VN">Vietnam</option>
<option data-prefix="1284" value="VG">Virgin Islands, British</option>
<option data-prefix="1340" value="VI">Virgin Islands, U.s.</option>
<option data-prefix="681" value="WF">Wallis and Futuna</option>
<option data-prefix="212" value="EH">Western Sahara</option>
<option data-prefix="967" value="YE">Yemen</option>
<option data-prefix="260" value="ZM">Zambia</option>
<option data-prefix="263" value="ZW">Zimbabwe</option>
</select>
<span class="help-block" for="country"></span>
</div>
</div>
<div class="row mb-3">
<div class="col-5">
<input class="form-control" type="text" id="post_code" name="post_code" placeholder="Post Code" required />
<span class="help-block" for="post_code"></span>
</div>
<div class="col-7">
<input class="form-control" type="text" id="phone" name="phone" placeholder="Phone" required />
<span class="help-block" for="phone"></span>
</div>
</div>
<div class="row mb-3">
<div class="col-12">
<div class="form-check">
<input class="form-check-input" type="checkbox" value="1" id="legalCheck" name="confirm1" required>
<label class="form-check-label" for="legalCheck">
By opening this account, I confirm that I have had access to, reviewed, read, understood, and accept
the full set of INGOT Brokers legal documents including the
<a target="_blank" href="#" id="jsc-legal-shared-docs">Terms & Conditions</a>,
<a target="_blank" href="#" id="privacy-policy">Privacy Policy</a>,
Product Disclosure Statement and Financial Services Guide
</label>
<span class="help-block" for="confirm1"></span>
</div>
</div>
</div>
<div class="row mb-3">
<div class="col-12">
<div class="form-check">
<input class="form-check-input" type="checkbox" id="newsletter" name="newsletter" placeholder="newsletter" value="1" />
<label for="newsletter" class="form-check-label">
Sign up to receive email and SMS updates on our
news, promotions, events and more</label>
</div>
<span class="help-block" for="newsletter"></span>
</div>
</div>
<div class="row">
<div class="col-12">
<input class="btn btn-dark w-100" type="submit" />
</div>
</div>
</form>
<link href="https://cdn.jsdelivr.net/npm/bootstrap@5.0.2/dist/css/bootstrap.min.css" rel="stylesheet">
<style>
.reg-form {
direction: ltr;
}
.reg-form a {
color: #000;
text-decoration: underline;
}
.reg-form .form-control {
padding: 0.75rem .75rem;
}
.reg-form .btn {
padding: .75rem .75rem;
}
.reg-form .has-error *,
.reg-form .help-block {
color: #cd2124 !important;
}
.reg-form .help-block {
width: 100%;
margin-top: 0.35rem;
font-size: 70%;
text-transform: lowercase;
display: block;
}
.reg-form .has-error .custom-file-label,
.reg-form .has-error .input-group-text,
.reg-form .has-error input,
.reg-form .has-error select,
.reg-form .has-error textarea {
border-color: #cd2124;
background: rgba(205, 33, 36, .2);
}
.reg-form .form-check .form-check-input {
float: revert;
margin-right: 3px;
margin-left: -1.5em;
}
.reg-form .form-check {
display: block;
min-height: 1.5rem;
padding-right: 0;
margin-bottom: 0.125rem;
padding-left: 1.5em;
}
.reg-form .form-select {
background-position: right 0.75rem center;
}
</style>
<script src="https://cdn.jsdelivr.net/npm/jquery@3.5.1/dist/jquery.min.js"></script>
<script type="text/javascript">
$(document).ready(function () {
var domain = "https://" + window.location.host.replace('campaign.', 'portal.');
var language = 'en';
var def_country = '';
var def_post_code = '';
$('#country').val(def_country);
$('#post_code').val(def_post_code);
$('#country').change(function () {
var countryCode = $('#country').val();
var prefix = $('#country option:selected').attr('data-prefix');
$('#post_code').val(prefix);
});
$.ajax({
url: domain + "/api/v1/ingot/get-account-form",
dataType: 'json',
headers: {
'Access-Control-Allow-Origin': '*',
},
data: {
'lang': language,
'domain': domain
},
success: function (response, textStatus, jqXHR) {
if (response.data) {
$account_form = response.data;
Object.entries($account_form).map(([key, value]) => {
if ($("#" + key).length != 0) {
document.getElementById(key).href = value;
}
})
}
},
error: function (jqXHR, textStatus, errorThrown) { }
});
$('#registrationForm').submit(function (e) {
e.preventDefault();
var first_name = $("input[name=first_name]").val();
var last_name = $("input[name=last_name]").val();
var email = $("input[name=email]").val();
var country = $("select[name=country]").val();
var phone = $("input[name=phone]").val();
var post_code = $("input[name=post_code]").val();
var newsletter = $("input[name=newsletter]").val();
var campaign_name = window.location.pathname.replace('/landing/', '');
$("#registrationForm").find("input, button, select").attr('disabled', true);
$.ajax({
url: domain + "/api/v1/ingot/create-application-get",
dataType: 'json',
headers: {
'Access-Control-Allow-Origin': '*',
},
data: {
'first_name': first_name,
'last_name': last_name,
'email': email,
'country': country,
'post_code': post_code,
'phone': phone,
'campaign_name': campaign_name,
'host': domain,
'lang': language,
'receive_email_and_sms': newsletter,
'referral': '11',
},
success: function (response, textStatus, jqXHR) {
if (!response.success) {
// enable enput
$("#registrationForm").find("input, button, select").attr('disabled', false);
// reset form
$("#registrationForm *").removeClass("has-error");
$("#registrationForm .help-block").text('');
// display error validation
$.each(response.data, function (key, value) {
$('#' + key).parent().addClass('has-error');
$('#' + key).next().text(value);
});
} else if (response.data.redirect_url) {
window.location.href = response.data.redirect_url;
}
},
error: function (jqXHR, textStatus, errorThrown) {
$("#registrationForm").find("input, button, select").attr('disabled', false);
}
});
});
});
</script>
