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1. Full Name: *

2. Company Name:

3. Contact Person Full Name:

4. Position:

5. Email: *

6. Telegram:

7. Phone:

8. Country of Residence: *

9. Timeline: *

Urgent under 2 weeks 2-4 weeks 1-3 months No specific deadline

10. Core Business Activity: *

11. Industry Vertical:

E-commerce SaaS FinTech Crypto/Blockchain Gaming Other

12. Monetization Model:

Subscription Transaction fees Advertising One-time payment Commission-based

13. Average Ticket Size:

14. Monthly Revenue:

15. Annual Revenue:

16. Source of Funds:

Business operations Investments Loans Personal funds Other

17. Customer and Supplier Locations:

18. Operating Regions:

Europe North America Asia Pacific Latin America Middle East & Africa Global

19. Settlement Currencies:

USD EUR GBP CHF Cryptocurrency Other

20. Partner Types:

Suppliers Service providers Distributors Payment processors Technology partners Other

21. Contract Countries/Companies:

22. Contracts with Government Entities:

Yes No

23. Signed Contracts (Already):

Yes No

24. Upload Contract Copies:

Choose file(s)

Accepted formats: PDF, DOC, DOCX

25. Do you need a bank account:

Yes No

26. Account Purpose:

Receiving payments Making payments Holding funds Trading operations

27. Bank Requirements:

Multi-currency Online banking SWIFT SEPA API integration

28. Required Payment Methods:

Credit/Debit cards Bank transfers Digital wallets Cryptocurrency Alternative payment methods

29. Planning to use cryptocurrency:

Yes No

30. Crypto Usage Purpose:

Accepting payments Making payments Trading Holding/Storage Investment

31. Crypto Assets:

Bitcoin Ethereum Stablecoins Altcoins Other

32. Need crypto operations legalization:

Yes No

33. Existing Crypto Infrastructure:

34. Plans for obtaining financial license:

Yes No Considering

35. License Type:

Payment institution EMI license Cryptocurrency license Banking license Other

36. License Purpose:

Compliance Market access Reputation Banking relationships

37. Readiness for regulatory requirements:

Ready Partially ready Need assistance

38. Ultimate Beneficial Owners (Name, Share %, Country):

39. Directors:

40. Citizenship/Passports:

41. Are there any PEPs (Politically Exposed Persons):

Yes No

42. Are there any sanction risks:

Yes No

43. Available Documents:

Company registration documents UBO documents Director documents Bank statements Business plan Financial statements Contracts Other

44. Prohibited/High-Risk Activities:

Gambling Adult content Pharmaceuticals Weapons Tobacco None

45. Chargeback risk:

Low Medium High

46. Owner anonymity required:

Yes No

47. Budget tolerance:

Low cost priority Moderate Quality over cost

48. Preferred Jurisdictions:

49. Top 3 Priorities:

50. Comments / Special Requirements:

Client Jurisdiction & General Information

1. Contact Details / General Information

2. Purpose of Request / Deliverables

3. Business Description / Revenue Model

4. Operational Geography

5. Partners / Counterparties

6. Banking / Payment Infrastructure

7. Crypto-Legal Structure

8. Licensing / Regulatory Plans

9. UBO, Directors, Ownership Structure

10. Documents / Preliminary Analysis

11. Risks / Restrictions / Important for Jurisdiction Selection

12. Final Questions