The information submitted on this form will be treated by CHIPSTIX as strictly private and confidential. Please help us by completing all sections carefully and thoroughly. This form will help you prepare and present personal information that is essential for our consideration in granting permission to trade as CHIPSTIX. The completion of this application form places no continuing obligation on either CHIPSTIX or you. CHIPSTIX welcomes applications from all sectors of the community regardless of gender, marital status, disability or ethnic origin.