Tell us how to get in touch with you:

First Name
Last Name
ID Number
E-mail
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Tel
Fax
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Information about your investment with LG

LG Client / Investment No.
Name of your broker / agent
Date of investment
Amount of Investment (Indicate R or US$)
Name of company you contracted with:	Please select Leaderguard Securities (Pty) Ltd) Leaderguard SpotForex Other

If you are a LG broker / Agent:

Are you an FSP or and LG representative.	Please select FSP LG
FSP Number (if applicable)
FSP Application number:
Total amount of investments placed with LG
Number of investors placed with LG
Your business name (if applicable)
Please submit each of your clients' details on a separate form.
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Additional Contact Information

Telephone:     +27 (0) 12 997 4638

Fax:                  +27 (0) 86 672 7128

Postal address: P.O. Box 100972, Moreleta Plaza, 0167