Introducing Broker Questionnaire


General Information
Full Name:
Company Name:
How did you hear about us?
Other. Please specify
Are you regulated? Yes  No
If yes, please name the regulatory body?
List Two Business References (Name, Address & Phone Number):
Business Information
Do you, currently, have clients that are ready to invest? Yes  No
If yes, how soon will these clients be ready to invest?
Are/Were you an Introducing Broker or Affiliate for other Money Manager(s)? Yes  No
If yes, please name the Money Manager(s) ?
What is the total amount you have referred to the other Money Manager(s)?
Do you have current relationships with Forex Dealers/ Brokers/FCMs? Yes  No
If yes, which FCMs:
What is the nature of your primary business?  
Trading proprietary accounts
Managing accounts
Raising money
Attracting clients for self-trading
Training and education
Other. Please explain:
Marketing Information
Please list all the geographic regions you are targeting or planning to target:
Briefly describe how you generate or solicit new clients:
Please specify the URL(s) of the Website(s) that the Company owns and intends to use to solicit clients for ICA :
What types of clients is the Company planning to target?  
Individual/Retail clients
High net worth individuals
Retired individuals
Fund managers, investment funds
Other. Please explain:


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