CIS

Client Information Sheet

Required information

Please attach:

- Copy of passport
- Corporate certificate in case of company

Client

Client name
Nationality/ies
Passport no(s)
Issue date/ expiration date
Social security no
Date of birth
Place of birth
Mobile no
Email address
Legal Address / Country

Company

Company name
Company activity
Registered office
Business telephone
Business email

Bank

Bank name
Bank name
BIC
Clearing no
Bank account name
IBAN
Beneficial Owner
BTC wallet

I the undersigned confirm that the information is right and correct and in best willing and understanding.
Confirmed by

_______________________________________________