BANKING BUSINESS SETUP FORM Here's What We Do Better Banking business setup form DETAILS OF YOUR DIGITAL CURRENCY BANK Proposed Name for Your Bank Proposed Domain Names for Your Bank: Propose at least 5 different domain names for your bank 1st Domain Name For Your Bank 1. 2nd Domain Name For Your Bank 2. 3rd Domain Name For Your Bank 3. 4th Domain Name For Your Bank 4. 5th Domain Name For Your Bank 5. Telephone Number for Bank Proposed Location of Your Bank (we will set up your bank address based on your preferred bank location): City State ZIP Country Your business logo URL DIGITAL CURRENCY EXCHANGE! Proposed Name for Your Digital Currency Exchange Proposed Domain Names for Your Business: Propose at least 5 different domain names for your Digital Currency Exchange 1st Domain Name For Your Digital Currency Exchange 1. 2nd Domain Name For Your Digital Currency Exchange 2. 3rd Domain Name For Your Digital Currency Exchange 3. 4th Domain Name For Your Digital Currency Exchange 4. 5th Domain Name For Your Digital Currency Exchange 5. Telephone Number for Digital Currency Exchange Proposed Location of Your Digital Currency Exchange (we will set up your bank address based on your preferred business location): City State ZIP Country Your business logo URL DIGITAL CURRENCY MARKETPLACE Proposed Name for Your Digital Currency Marketplace Proposed Domain Names for Your Digital Currency Marketplace Propose at least 5 different domain names for your Digital Currency Marketplace 1st Domain Name For Your Banking Platform 1. 2nd Domain Name For Your Digital Currency Marketplace 2. 3rd Domain Name For Your Digital Currency Marketplace 3. 4th Domain Name For Your Digital Currency Marketplace 4. 5th Domain Name For Your Digital Currency Marketplace 5. Telephone Number for Digital Currency Marketplace Proposed Location of Your Digital Currency Marketplace (we will set up your bank address based on your preferred business location): City State ZIP Country Your business logo URL DIGITAL CURRENCY BANKING PLATFORM Proposed Name for Your Banking Platform Proposed Domain Names for Your Banking Platform Propose at least 5 different domain names for your banking Platform 1st Domain Name For Your Banking Platform 1. 2nd Domain Name For Your Banking Platform 2. 3rd Domain Name For Your Banking Platform 3. 4th Domain Name For Your Banking Platform 4. 5th Domain Name For Your Banking Platform 5. PARTICULARS OF ACCOUNT (PLEASE USE INK AND BLOCK CAPITAL LETTERS, IN OTHER CASES PLEASE TICK CLEARLY THE APPROPRIATE BOX) TYPE OF ORGANISATION(Please tick where applicable) Branch Checkboxes Sole Proprietorship Association Club and Societies Company Limited by Liability MMDA’s Company Unlimited by Liability Company Unlimited by Guarantee Company Limited by Guarantee Partnership Registered/Unregistered Church Other (Specify)Other (Specify) PROFILE OF ORGANISATION Name of Business Parent Country of Inc. Subsidiary (if any) Nature of Business Registration no. Date of issue Jurisdiction of Incorporation/Registration Date of Commencement Date of Incorporation/Registration Tax Identification No. Tax Identification No. (US) Sector/Industry Address of principal place of business (Please provide landmark) Mailing Address Phone Type Telephone No(s) Fax No(s) E – Mail Address Website (if any) City of Location Account with other banks Name of the bank and Branch Account number Account name Status Active Dormant ADD MORE BANK ACCOUNTS REMOVE DETAILS OF PARTNERS / PROPRIETOR / DIRECTORS / EXECUTIVES/ TRUSTEES/ PROMOTERS/ADMINSTRATORS Name Contact number (s) 2nd Contact number Email Address Res. Address City/Town/Region Date of Birth Nationality Residence Permit Number (if applicable) Type of Identification ID No ID Issue Date ID Expiry Status of Director Active Inactive Occupation Job Title/ Position Gender Male Female ADD MORE DIRECTORS/PARTNERS/EXECUTIVES... REMOVE KEY CONTACTS PERSON(S) / PRINCIPAL OFFICER(S) Name Contact number (s) 2nd Contact number Email Address Res. Address City/Town/Region Date of Birth Nationality Mother’s Maiden name Residence Permit Number (if applicable) Type of Identification ID No ID Issue Date ID Expiry Status of Persons Active Inactive Occupation Job Title/ Position Gender Male Female ADD MORE KEY CONTACTS PERSONS REMOVE OTHER PERSONS WITH CONTROL OVER THE BANK NOT LISTED IN REGISTRATION DOCUMENT Name Contact number (s) 2nd Contact number Email Address Res. Address City/Town/Region Date of Birth Nationality Mother’s Maiden name Residence Permit Number) (if applicable) Type of Identification ID No ID Issue Date ID Expiry Status of Persons Active Inactive Occupation Job Title/ Position Gender Male Female ADD MORE PERSONS REMOVE DETAILS OF SHAREHOLDERS (Shares of 10% and above) Auditor Name Name of Secretary Number of Shareholders Repeater Name Contact number (s) 2nd Contact number Email Address Res. Address City/Town/Region Date of Birth Nationality Mother’s Maiden name Residence Permit Number (if applicable) Type of Identification ID No ID Issue Date ID Expiry Status Of Share Holder Occupation Job Title/ Position Gender Male Female Registration Certificate No. (Corporate Shareholder) Country of incorporation (if corporate shareholder) Name of Beneficial Owner(s) (If corporate shareholder) Percentage of Shareholders % ADD MORE SHAREHOLDERS REMOVE DETAIL OF SIGNATORIES Repeater Name Contact number (s) 2nd Contact number Email Address Res. Address City/Town/Region Date of Birth Nationality Mother’s Maiden name Residence Permit Number) (if applicable) Type of Identification ID No ID Issue Date ID Expiry Status Of Share Holder Occupation Job Title/ Position Gender Male Female ADD MORE SIGNATORIES REMOVE ADDITIONAL INFORMATION (AFFILIATED COMPANIES/ BODY) Repeater Name of Affiliated Company /Body Full Name of Principal Shareholder Address Status Percentage Holding % Mobile Number Nationality Gender Male Female Registration Cerificate No.(Corporate Shareholder) Country of Incorporation (if a corporate shareholder) ADD MORE AFFILIATED COMPANIES/ BODIES REMOVE SIGNATURE/MANDATE How to sign: NAME CLASS OF SIGNATORY SAMPLE SIGNATURE 1 SAMPLE SIGNATURE 2 1st Signature Name 1st Class Of Sign 1st Sample Signature 1 Clear 1st Signature Sample 2 Clear 2nd Signature Name 2nd Class Of Sign 2nd Sample Signature 1 Clear 2nd Signature Sample 2 Clear 3rd Signature Name 3rd Class Of Sign 3rd Sample Signature 1 Clear 3rd Signature Sample 2 Clear 4th Signature Name 4th Class Of Sign 4th Sample Signature 1 Clear 4th Signature Sample 2 Clear SIGNING INSTRUCTIONS AS PER RESOLUTION NOMINATING SIGNATORIES HOW DID YOU GET TO KNOW ABOUT THIS OPPORTUNITY? Checkboxes TV/Documentary Radio Brochure Newspaper Website/Email An event (specify) Word of mouth (please indicate person’s name) Please specify others… (for illiterate and blind customer(s) only) Verification I (name of client) …………… hereby confirm that the contents herein have been read and explained to me in the …………… Language by (name of WTE staff) …………… and I perfectly understand and approve of same and in testimony of which I hereby set my mark below. Illiterate or Blind Signature Clear (THUMBPRINT/SIGNATURE/MARK OF CLIENT) (Name of Client) Signature Clear (THUMBPRINT/SIGNATURE/MARK OF INTERPRETER) (Name of Interpreter) Submit
