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full Name*
Email Address*
Facebook Profile
Instagram Profile
LinkedIn profile
Twitter profile
Will you have a power of attorney over accounts introduced?
Will you be actively assisting accounts on a day to day basis? 
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Will you provide advisory services to Accounts?
 Will you perform discretionary trading on behalf of clients?
Will you provide any other services to the clients?
Do you currently act as an Introducer with other companies?
Do you have an office?
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Current number of clients
Territories in which clients are located?
Channels used to attract new business:
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Were you subject of any disciplinary proceedings of any exchange, regulatory authority, government body or agency, or is it aware that such proceedings are pending?
Geomatrix Limited will only enter into a Country Representative Agreement, or similar arrangement with you if it considers such an arrangement suitable. To determine suitability, 4XC will rely on the information that you provide in this form.