Bitbuy - Business Account On-boarding

PRIVATE AND CONFIDENTIAL: All information submitted through this form is kept confi-
dential between Bitbuy and the client providing it.

Full name *

Bitbuy verified account e-mail address: *

Purpose for buying and selling digital currency? *

If you are planning on sending your digital currency to another platform, where
do you plan on sending it? *

How did you find out about Bitbuy? *

If you have a point of contact at Bitbuy, please provide their name

Doing business as (DBA), if applicable

Brief description of the business / Nature of Business and investment intent (Be
Specific) *

Bitbuy - Business Account On-boarding 01/09

Incorporation Number or Business Number *

Jurisdication (local/foreign i.e. provincial) *

What industry does the business operate within? (Be Specific) *

Does the business have a website? *

Yes No

If you answered yes to the previous question please provide the website:

What is your expected monthly transaction volume? *

Under 10k 10K - 20K 20K - 50K

50K - 100K 100K plus

Third Party
Are you acting on behalf of a "Third Party"? That is, a "Third Party" is a person
(individual or company or organization) other than you that receives face value
funds or crypto for this account. Example of a Third Party: Payor, Executor, Power
of Attorney. *

Yes No

Third Party - More Info. Required

Third Party - More Info. Required *

Bitbuy - Business Account On-boarding 02/09

Senior Position of Public Trust
Do you hold or have you held a senior position of public trust such as a govern-
ment official, politician, judge, military leader or important political party official
in a domestic or foreign government? Or have you ever been the Head of an
International Organization? (i.e. Olympic Committee) *

Yes No

Senior Position of Public Trust - More Info. Required

If you answered YES to the previous question, please describe the position
and dates it was held. *

Jurisdication (local/foreign i.e. provincial)

Senior Position of Public Trust

Are you a family member OR a close associate of a person who has held a
senior position of public trust such as a government official, politician, judge,
military leader, or important political party official? **

Yes No

Senior Position of Public Trust - More Info. Required

If you answered YES to the previous question, please describe the position
and dates it was held. *

Type of Business

Type of Business *

Corporation Sole Proprietorship Partnership Trust

Other (Charity, Public Corporation)

Bitbuy - Business Account On-boarding 03/09

Authorized Individuals

Please provide the below information for all individuals with authorization to act
on behalf of the business (Operator, Accountant, President, Secretary, Treasurer,
Signatory etc.)

I am the sole authorized individual, director, and shareholder of this company. *

Yes No

Primary bank to fund Bitbuy

Authorized Individuals Information

If you answered "No" to the previous section, please provide additional informa-
tion on Authorized Individuals.

Authorized Individual 2 - Full Name

Authorized Individual 2 - Address(es) (Street, City, Province, Postal Code):

Authorized Individual 2 - Mobile Phone

Authorized Individual 2 - Date of Birth (MM/DD/YYYY).

Directors

I am the only director of the company

Yes No

Additional Director Information

If you answered "No" to the previous section, please provide additional informa-
tion on directors.
Bitbuy - Business Account On-boarding 04/09
Director 1 - Full Name

Director 1 - Address(es) (Street, City, Province, Postal Code)

Director 1 - Mobile Phone

Director 1 - Date of Birth (MM/DD/YYYY)

Are there additional directors?

Yes No

Additional Director Information

If you answered "Yes" to the previous section, please provide additional informa-
tion on directors.

Director 2 - Full Name

Director 2 - Address(es) (Street, City, Province, Postal Code)

Director 2 - Mobile Phone

Director 2 - Date of Birth (MM/DD/YYYY).

Are there additional directors?

Yes No

Bitbuy - Business Account On-boarding 05/09

Additional Director Information
If you answered "Yes" to the previous section, please provide additional informa-
tion on directors.

Director 3 - Full Name

Director 3 - Address(es) (Street, City, Province, Postal Code)

Director 3 - Mobile Phone

Director 3 - Date of Birth (MM/DD/YYYY)

Are there additional directors?

Yes No

Additional Director Information

If you answered "Yes" to the previous sections, please provide additional infor-
mation on directors.

Director 4 - Full Name

Director 4 - Address(es) (Street, City, Province, Postal Code)

Director 4 - Mobile Phone

Bitbuy - Business Account On-boarding 06/09

Director 4 - Date of Birth (MM/DD/YYYY)

If there are additional directors then please contact a Bitbuy representative

Shareholders

I am the only shareholder that owns greater than 25% of the company?

Yes No

Do you have a shareholders registrar?

Yes No

Additional Shareholder Information

If you answered “Yes”, please upload directly to your account.

If you answered “No” to the previous section please provide additional

information on the shareholders.

Shareholder 2 - Full Name

Shareholder 2 - Address(es) (Street, City, Province, Postal Code)

Shareholder 2 - Mobile Phone

Shareholder 2 - Date of Birth (MM/DD/YYYY)

Bitbuy - Business Account On-boarding 07/09

Are there additional shareholders?

Yes No

Additional Shareholder Information

If you answered “yes” to the previous section please provide additional informa-
tion on the shareholders.

Shareholder 3 - Full Name

Shareholder 3 - Address(es) (Street, City, Province, Postal Code)

Shareholder 3 - Mobile Phone

Shareholder 3 - Date of Birth (MM/DD/YYYY)

Are there additional shareholders?

Yes No

Additional Shareholder Information

If you answered yes to the previous section please provide additional informa-
tion on the shareholders.

Shareholder 4 - Full Name

Shareholder 4 - Address(es) (Street, City, Province, Postal Code)

Bitbuy - Business Account On-boarding 08/09

Shareholder 4 - Mobile Phone

Shareholder 4 - Date of Birth (MM/DD/YYYY)

Are there additional shareholders?

Yes No

Regulated Entity Information

Is your business a regulated or a self-regulated entity under the Proceed of

Crime (Money Laundering), and Terrorist Financing Act?

Yes No

If Yes, please tick those that apply:

Money Service Business

Real-Estate Agent/Broker
Financial Institution (Bank, Trust, etc)
Securities - Broker Dealer
Accountant
Casino
Lawyer
Other. Please Specify _______________

If you answered MSB to the previous question, please provide us with your MSB
registration number:

Bitbuy - Business Account On-boarding 09/09