MERCHANT APPLICATION

Company

Address

Shareholders

Activity

Contact

Registered Address & Contact

Registered Address: City: Postal Code: Country: Phone Number: Email Address: Websites: Proof of Address for the Business:

Bank Statement:

Utility Bill:

Director Names (Full legal names): Shareholders (up to 4):

Passport/ID:

Proof of Address:

Ultimate Beneficial Owner(s):

Projected Monthly Transaction Volume: Expected Number of Transactions: Transaction Currencies: Main Countries of Trade:

This is a new business and does not have processing activity or enough processing activity to provide transaction files

How will you provide transaction data for the last 3 months?

Upload 3 separate CSV files (1 per month)

Upload one CSV file covering all 3 months

Last 3 Months Processing Volume (CSV files only):

Please upload CSV files containing your transaction data for the last 3 months

Month 1:

Month 2:

Month 3:

Additional File (optional):

Source of Funds: Purpose of Account: Does your company deal with cryptocurrencies?

Yes No

Please provide your contact details so we can follow up with you

Full Name: Email Address: Mobile Number:

FUJI EXCHANGE LIMITED 1 HUNTER STREET EAST GROUND FLOOR, HAMILTON, Ontario, Canada, L8N 3W1 Reg: 1207636-5, FINTRAC License Ref. M20252473

Contact: info@skypaygate.com