Cryptocurrency Exchange Sanctions Compliance Questionnaire Form
Complete this Cryptocurrency Exchange Sanctions Compliance Questionnaire Form to help us meet regulatory requirements and ensure a safe trading environment.
Full Name
*
First Name
Last Name
Date of Birth (Year Only)
*
Country of Residence
*
Please Select
United States
United Kingdom
Canada
Australia
Germany
France
Singapore
Other
Nationality
*
Please Select
United States
United Kingdom
Canada
Australia
Germany
France
Singapore
Other
Email Address
*
example@example.com
Phone Number (optional)
Please enter a valid phone number.
Format: (000) 000-0000.
Are you or any immediate family member a Politically Exposed Person (PEP)?
*
No
Yes
Have you or any associated entity been listed on international sanctions lists?
*
No
Yes
What is the primary purpose for opening this account?
*
Please Select
Personal investment/trading
Business-related activity
Receiving salary or payments
Other
Please specify the source of funds for your transactions
*
Please Select
Salary or employment income
Business profits
Savings or investments
Gift or inheritance
Other
Submit
Should be Empty: