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Partners

Onboarding Exchange Form

General Information

Registered Business Name

Business Brand Name

Company Registration Number

VAT Number

Number of Employees

Business Start Date

Do you hold or are you planning to apply for an authorization or a license with a financial regulator? If yes, please specify what type of authorization/license?

Articles of Incorporation

Crypto-currencies Activity

Have you accepted credit cards in the past/today?

YesNo

What is your current or expected number of credit/debit card transactions per month?

What is your current or expected average credit card transaction amount?

Are you a Wallet Service Provider?

YesNo

Wallet Service Provider Comments

Is the Crypto of the End User held in a Hot or Cold Wallet?

Hot WalletCold Wallet

Wallet Service Provider Comments

Is the Private Key held by the End User?

YesNo

Private Key Comments

Do you have security measures in place in order to protect your end users' crypto?
If so, please provide details

Do you have a plan in order to cover lost funds if crypto is stolen from your system?
If so, please provide details

Other Crypto-currencies

Crypto currencies planned for future trade

Business Model

Please describe in details what is your company's business model - what the company has been doing until now

Please describe in details how do you see the business model and funds flow in cooperation with Simplex

What is your website address to work with Simplex?

Does your company have other websites?

YesNo

Name the websites addresses

Business Operational Details

Country	State / Province / Region
City	Address
Postal / Zip Code	Business Phone

Business Registered Details

The same as Operational Address
Country	State / Province / Region
City	Address
Postal / Zip Code	Business Phone

European Entity

Does your company have a EU registered entity?

YesNo

EU Entity
Comments

Does your company have a EU director?

YesNo

EU Director
Comments

Does your EU entity have a physical address in EU?

YesNo

EU Address
Comments

Do you have a bank account in the name of your EU entity?

YesNo

EU Address
Comments

Contact Person Information

First Name	Last Name
Contact Phone	Contact Email
Contact Country	Contact State / Province / Region
Contact City	Contact Address
Postal / Zip Code	Title at the Company

Business Owner / Founder Information

Number of owners the business has?	Does the contact person is the owner? YesNo
Owner First Name	Owner Last Name
Owner Phone	Owner Email
Owner Country	Owner State / Province / Region
Owner City	Owner Address
Owner Postal / Zip Code	Title at the Company

Second Business Owner / Founder Information

Second Owner First Name	Second Owner Last Name
Second Owner Phone	Second Owner Email
Second Owner Country	Second Owner State / Province / Region
Second Owner City	Second Owner Address
Second Owner Postal / Zip Code

Third Business Owner / Founder Information

Third Owner First Name	Third Owner Last Name
Third Owner Phone	Third Owner Email
Third Owner Country	Third Owner State / Province / Region
Third Owner City	Third Owner Address
Third Owner Postal / Zip Code

Fourth Business Owner / Founder Information

Fourth Owner First Name	Fourth Owner Last Name
Fourth Owner Phone	Fourth Owner Email
Fourth Owner Country	Fourth Owner State / Province / Region
Fourth Owner City	Fourth Owner Address
Fourth Owner Postal / Zip Code

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Contact Information