IB (Introducing Broker) Agreement Form

1. INTRODUCING BROKER INFORMATION (mandatory)

General Information

Corporate Entity

Corporate Entity :

Country :

Registration No.:

Email:

Country :

Email:

Full Name:

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Social Security No.:

Date of Birth:

Home Address:

ID Number:

Mobile Phone:

Full Name:

Social Security No.:

Date of Birth:

Home Address:

ID Number:

Mobile Phone:

References

References

(Business and/or Bank)

(Corporate attorney)

Mobile Phone Number:

Principles

Registered Address:

Phone Number:

Phone Number:

Name:

Name:

Address:

Phone Number:

Name:

Address:

Phone Number:

References (Business and/or Bank)

Name:

Address:

Phone Number:

Name:

Address:

Phone Number:

Name:

Address:

Phone Number:

Name:

Address:

Phone Number:

Surname:

Registered Address:

Individual

©Principal Forex Inc. & PrincipalFX.com All rights reserved. Global Business License No. 22707/IBC.

a. Website

Finance: Forex:

f. Are there any issues with clients, regulators or similar authorities that we should know about?

2. Are you already an introducing broker to Principal FX or any other Liquidity Provider?

Yes

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No

3. PROFESSIONAL EXPERIENCE OF FINANCIAL MARKETS (mandatory)

Yes No

Yes No

IB (Introducing Broker) Agreement Form

ID:

If yes, please indicate:

b. Please briefly describe the business activity:

c. In addition mark with an x if you offer some of the following services:

Introducing clients/Agents Advisory Training Signals Alerts Web Others

d. Years of experience in:

e. Are any regulatory license(s) required by the financial authorities?

If yes, state which?

Yes No

Yes No

If yes, Which providers?

Are you regulated? By whom?

Conflicts: Cases in Courts:

g. Have you referred clients to other providers?

h. Does the IB currently utilize any means of marketing or promotional material?

If yes, please check all types of marketing means currently being utilized by IB:

Newspaper/Magazine Television Direct Mail

RadioSeminars Internet

Other (Please specify)

When in possession of website, please list the website address:

©Principal Forex Inc. & PrincipalFX.com All rights reserved. Global Business License No. 22707/IBC.

a. Country of residence of introduced clients:

c. What type of clients do you intend to introduce to Brokersclub Ltd(professional or retail clients, HNW individuals, institutional clients)?

e. Commission structure

Do you plan to charge commission? Yes No

If yes, please specify the commission per lot:

Expected number of clients within:

1 month: 3 months: 6 months: 1 year:

IB (Introducing Broker) Agreement Form

4. IB BUSINESS MODEL (mandatory)

Yes

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No

Countries of residence:

% of total client base

b. Are you aware about risks of cross border business?

Details:

Details:

d. Promotion scheme of services

Passive solicitation(Clients contact you, selective networking)

Active solicitation(Your network contacts clients open advertising)

What spreads do you want your clients to trade on? Standard spreads Increased spreads

5. EXPECTED COMMERCIAL ACTIVITY BETWEEN IB & BROKERSCLUB LTD (mandatory)

Expected average initial investment per client (in EUR):

Expected total number of traded lots round turn per month in the first year:

Signature : Date :

IB Name :

©Principal Forex Inc. & PrincipalFX.com All rights reserved. Global Business License No. 22707/IBC.