DECLARATION OF DEPOSIT

I, _________________________________________________________________________________________________, the undersigned,

bearer of Passport / National ID _________________________, Date of Birth ________________________,
Trading Account number ____________________________________________________________________ , hereby declare that:

By submitting this form along with the additional information requested to Capitalix, consisting of 4Square CY Ltd, a company duly registered in Cyprus with
the address 256 Makarios Avenue, 3105, Limassol, Cyprus which operates the brand and the company 4Square SY Ltd duly registered in Seychelles with the
address at Block B, Room 6, No.2 Global Village, Jivan’s Complex, Mont Fleuri, Mahe, Seychelles, I am authorizing and fully acknowledging the following:

a) I have agreed to engage 4Square SY Ltd (hereinafter called the “Company”) under the Terms and Conditions publicly available on our website
www.capitalix.com here and agreed by the undersigned as amended; and receive the relevant investment services.

b) I understand that this document is essential in order to comply with the Company’s Anti Money Laundering Policy to meet a worldwide standard of a
regulatory bodies, and the major credit card issuing bodies involved in the transaction(s).

c) The transactions listed on the table below were made by me for trading purposes and authorized by me to be cleared on my behalf – with a purpose of
funding my personal trading account with the Company.

d) Each deposit I make or authorize to be cleared on my behalf will follow with a Declaration of Deposit, and that would be my responsibility to provide.

e) I understand that my personal account with the Company is for my own personal use for self-trading purposes.
If I allow a third party to trade on my behalf, it will be done at my own risk and in any case event I will not hold the Company liable.

f) I hereby to confirm I have self-registered on the website www.capitalix.com and engaged with the Company on a reverse solicitation basis.

g) By authorizing a further deposit, I confirm and acknowledge satisfactory provision of service by the Company, I have no claims towards the services
given, the deposits and the trading have been done on my own initiation.

h) I understand that all the trading activities on my account are my responsibility, and I acknowledge that there is a risk of loss associated with the
trading.
i) I am the authorized cardholder and will honor all purchases initiated by me to my trading account with the below credit/debit card / cards details.

j) I am of age 18 years or older

Transaction Deposit Amount Currency Card Deposit Wire Deposit Signature

Reference Date Input last 4 Input Bank Account
digits ONLY Number

Customer agrees the information held on file and submitted on this form is true, valid, and accurate.

Date Signature

RISK WARNING:
Forex/CFDs trading involves significant risk to your invested capital. Please read and make sure that you fully understand our Risk Disclosure
Policy.

4SQUARE SY LIMITED’s Terms & Conditions, Privacy Policy, Cookies Policy, Conflicts of Interest Policy, Orders Execution Policy, Risk Disclosure
and Complaint Handling Policy are available on our website www.capitalix.com.