Cryptocurrency Securities Compliance Waiver Form
Complete this form to acknowledge the compliance waiver and provide the details needed to review your cryptocurrency securities-related activity.
Participant Information
Full Name
*
First Name
Middle Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Entity and Role
Organization / Company Name
*
Role / Title
*
Relationship to Cryptocurrency Activity
*
Investor
Representative
Advisor
Employee
Other
Activity Details
Cryptocurrency Asset or Project Name
*
Type of Activity
*
Token Purchase
Token Sale
Transfer
Advisory Engagement
Listing-Related Review
Other
Notes / Details
Submit Form
Should be Empty: