Registration Registration Form A. DETAILS OF THE CORPORATE ENTITY Labels with * are mandatory input fields Company name * Entity type * —Please choose an option—Sole ProprietorshipPartnershipCorporationLimited Liability Company (LLC)Others Registration number Date of incorporation Country of registration * Website URL Address line 1 Address line 2 Town / City * State / County * Postcode / Zip code Country * B. FULL LIST OF DIRECTORS AND OFFICERS Full name 1 Full name 2 Full name 3 Full name 4 C. PRIMARY CONTACT PERSON Full name * Position Contact number * Email address * D. ADDITIONAL CONTACT PERSON (IF APPLICABLE) Full name Position Contact number Email address E. INFORMATION ON CORPORATE ENTITY Nature of the business (please provide as much detail as possible) Source of funds (please provide evidence) Entity's net worth (assets less liabilities) Estimated volume per month Estimated trades per month Intended assets to trade Intended purpose of the account (Please tick appropriate choice) SpeculativeBrokeringHedgingFacilitating commerce Has the entity carried out 10 or more significantly sized transactions (€10,000 or more) in the relevant market, in the previous four quarters? Yes Does the entity have an investment portfolio in excess of €100,000? Yes Does the entity and/or designated trader have knowledge and experience within the financial sector, or has worked in a professional position for over a year, which requires knowledge of the transactions and services envisaged? Yes Has the entity, or any of its directors, ever been declared bankrupt? Yes Are any of the entity's shareholders or directors a politically exposed person? Yes F. DESIGNATED TRADER (IF APPLICABLE) Full name Position Contact number Email address G. ADDITIONAL TRADER Full name Position Contact number Email address H. OWNERSHIP OF THE ENTITY Identify every individual or entity who directly or indirectly, through contract, arrangement, understanding, relationship or otherwise, owns 10% or more of the equity interest in the legal entity applying to trade. Full name Percentage ownership I. ADDITIONAL SHAREHOLDER 1 Full name Percentage ownership J. ADDITIONAL SHAREHOLDER 2 Full name Percentage ownership K. ADDITIONAL SHAREHOLDER 3 Full name Percentage ownership L. BANKING INFORMATION Bank name Bank address Account name Sort code / Routing Number / BIC / SWIFT Account number / IBAN Currency Intermediary bank (If known) M. REQUIRED INFORMATION FOR LEGAL ENTITY Please submit all below information regarding the legal entity to this application. Please tick all boxes that are supplied. Certificate of incorporationDirectors registerMemorandum and articles of associationShareholders registerProof of address for the legal entitySource of funds N. REQUIRED INFORMATION FOR INDIVIDUAL(S) Please submit all below information regarding the directors, shareholders and designated traders associated with the legal entity for this application. Please tick all boxes that are supplied. Proof of identity for all directorsProof of address for all directors*Proof of identity for all shareholders >25%Proof of address for all shareholders >25%*Proof of identity for all designated tradersProof of address for all designated traders* *Utility bill or bank statement dated within 3 months. Please note, we do not accept credit card or mobile telephone bills. O. TERMS AND CONDITIONS I, on behalf of the legal entity, accept that Vorto Digital Asset Management s.r.o must comply with anti-money laundering regulations and that I authorize Vorto Digital Asset Management s.r.o the use of the information provided on this form to conduct anti money laundering checks.I, on behalf of the legal entity, understand that cryptocurrency are highly volatile assets, that the value can go up or down very quickly, and therefore my invested capital is at risk.I, on behalf of the legal entity, accept full liability for all losses incurred should the cryptocurrency if purchased go down in value, or if the wallet the cryptocurrency is received into is lost.I, on behalf of the legal entity, confirm that all details supplied within this application are correct and accurate to my best knowledge on the date signed for below.I, on behalf of the legal entity, accept Vorto Digital Asset Management s.r.o's AML & CTF Policy which is available on the website vd.am.coI, on behalf of the legal entity, accept Vorto Digital Asset Management s.r.o's Trading Terms and Conditions which are available on the website vd.am.co Signed By: Position: Name: Date: Δ
