FCMs THAT GUARANTEE OR PLAN TO GUARANTEE

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FCMs THAT GUARANTEE OR PLAN TO GUARANTEE Powered By Docstoc
					                                 Guaranteed Introducing Broker
                                       Verification Form
Use this form to request information about an Introducing Broker that your firm wishes to guarantee.
Please print the form, sign it, mail it or fax it to National Futures Association at the address below.

I, _________________________________, on behalf of _______________________________,
          (print name)                                 (Name of FCM)

either guarantees or plans to guarantee the following Introducing Broker:


        _______________________________________
        Name of IB


        _______________________________________
        Address


        _______________________________________
        Address


        _______________________________________
        City, State, Zip Code


        _______________________________________
        Telephone Number


I further certify that I am authorized to act on behalf of _________________________________
                                                                (name of FCM)
and that the information requested from the registration records maintained by National Futures
Association is sought in connection with the guarantee agreement which the above-referenced IB has
entered into with us or plans to enter into with us.

         I understand that the information to be disclosed by National Futures Association is non-public
and is disclosed solely to assist Futures Commission Merchants in either determining whether to
guarantee an Introducing Broker, or in monitoring the caliber of Introducing Brokers, and employees
thereof, for which the Futures Commission Merchant is currently acting as guarantor. I further represent
that the use of the information will be limited to the above-stated purpose.

                                                           _________________________________
National Futures Association                               Signature and Title
300 South Riverside Plaza
Suite 1800
Chicago, IL 60606                                          _________________________________
Attn. Document Research Group                              Date
Fax: (312) 781-1459

				
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