I {FirstName} {LastName} holder of the trading account number {Client:TpAccountList}  with NordMarket.com, residing at {Client:Country}  I hereby represent, warrant and confirm, the following:

1. I have independently, on my own exclusive initiative and for my own accord personally requested to be provided with the following investment services and/ or activities by ALL NEW INVESTMENTS (VA) LTD outside the EEA Countries (the ‘Company’):

• Reception & Transmission of orders
• Execution of orders

Date: 

Name: 

Signature :