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* Required fields

* Username Note: Usernames are case sensitive.

* Password This must consists of upper cases, lower cases and numbers

* Confirm password

* Email address

Email subscription Send me newsletters and promotional emails.

* Country

* Choose a plan Choose which plan you would like to subscribe to.

* First name

* Your last name

* Date of Birth Correct format : YYYY-MM-DD

* Individual / Non-individual Individual: application by an individual person. Non-individual: application by a legally registered company or business entity.

Individual
Non-individual

If non-individual: Business / Company

Business / Company Registration Number

* Country Dial Code Prefix needed to dial the mobile phone from another country

* WhatsApp number

* Country Dial Code Prefix needed to dial the mobile phone from another country

* Mobile number

* Address

* Town/City

* State/Province

Postal/Zip code

Your Skype ID

Please provide a direct link (URL) where you plan to promote Deriv.com. E.g., your website, YouTube channel, Telegram or WhatsApp group, Facebook page, Instagram, or Medium

Tell us how you're planning to promote Deriv.com.

* Are you of age 18 or older?

I can confirm I am over 18 years old.

* Terms and Agreement

I have read and agree to the Affiliate Terms of Service