| Client’s Details: | |
| Name: | |
| Account Number: | |
| Complaint Details: | |
| FOREX | |
| Cause for the complaint? | |
| What do you expect? | |
| Please fill additional fields if a specific order is affected: | |
| Order ID number: | |
| Date and time (GMT): | |
| Lots (Volume): | |
| Currency Pair instrument: | |
| Difference in PIPS: | |
| Signature: | |
| Date: | |
| Customer Signature: | x |
Vertis Invest will handle the complaint promptly and comment on it. Please send the complaint form to our compliance department: [email protected].