Dear razaq i need this information, please get some free

time and fill it as early as possible for the further

procedure.

Name of IB:
Main Address:
Telephone:
Fax:
Email:
Name of Contact:

Firm Formation Date:

Business Type :(slect One): Sole Proprietor

Partnership Limited Liability Corp.
Corporation

Number of Associated Persons (AP):

Number of Branch Offices:

Is IB a member of any financial exchanges? Yes No

If yes, please list:
Securities Registrations:

List Two Business References (Name, Address & Phone

Number):

1.
__________________________________________________________________
________________
__________________________________________________________________
________________

2.
__________________________________________________________________
________________
__________________________________________________________________
________________

List a Bank Reference (Name, Address & Phone Number):

List your Attorney (Name, Address & Phone Number):

Section 2: Business Information

Current Liquidity Provider Relationships:

Past Clearing Relationships:

Total Number of Accounts:

Total Customer Funds:

Average Account Size:

Average Round Turns traded per month:

Average ticket size in standard lots:

Which other electronic order entry platforms do you use?

Please list all countries in which your customers are

located:

For each type of account listed, indicate the percentage

that type of account represents of the IBs overall
customer account business:

Type

Individual

Institutional

Managed

Percentage

Does the IB charge any fees? Yes No

If yes, please explain:

Section 3: Sales / Marketing / Promotion

Briefly describe how you generate or solicit new business:

Does the IB currently utilize any means of marketing or

promotional material: Yes No

If yes, please check all types of marketing means currently

being utilized by IB:

Newspaper/Magazine Seminars

Television Internet

Radio Other (Please specify)

___________________________________

Direct Mail
________________________________________________________

List any other information that you feel is necessary:

Completed
by_______________________________________________________
Date________________

Signature_______________________________________________________
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