CURRENT ACCOUNT APPLICATION FOR LEGAL ENTITIES

INSTRUCTIONS FOR COMPLETING THE APPLICATION FORM

No question should be left unanswered. Where the applicant believes that a question does not apply, they should write “Not Applicable”, “N/A” or “NA”.
The information supplied by you will enable us to handle your application and ongoing relationship efficiently. The information we request is required in order to ensure
that we meet our Anti-Money Laundering and Know Your Customer obligations. You will need to submit an Application form for each entity that is applying for account
services. By signing this form, you consent to BILDERLINGS PAY making such enquiries as it may need to verify any of the information provided herein.
This form should be filled in electronically, printed, signed and returned to BILDERLINGS PAY.
This form is required for Know Your Customer (KYC) Validation as part of our Financial Services Authority (FCA) requirements. All information required is mandatory
and failure to update any part thereof may delay your application with BILDERLINGS PAY.
If you have any queries regarding the completion of this application, please contact:
Bilderlings Pay Limited | Direct Dial Telephone: +44 203 936 8203 | Email: accounts@bilderlings.eu

1. CLIENT INFORMATION
1.1 Company Name 1.2 Registration No. 1.3 Date of registration
___ /___ / ______
dd mm yyyy
1.4 Legal address (Street, City, Postal code, Country)

1.5 Office address (Street, City, Postal code, Country)

2. CARD INFORMATION
2.1 Cardholder information
2.1.1 Name, Surname on the card (latin letters only, maximum 22 characters)

2.1.2 Company name on the card (latin letters only, maximum 24 characters)

2.1.3 Voice password (for communication by phone) (numbers and/or Latin letters from 4 to 20 characters) 2.1.4 Phone number

2.2 Card delivery

2.2.1 Recipient (Name, Surname) 2.2.2 Delivery address (street, flat/house No)

2.2.3 City 2.2.4 Country 2.2.5 Postal code 2.2.6 Phone number

2.2.7 Delivery type*

5-20 working days (Post free)

3-10 working days (Courier)

*Card delivery to Ukraine and CIS countries available only by courier

3. BUSINESS PROFILE

Agriculture, forestry and fishery Extraction industry, quarry operations

Processing industry Electricity, gas supply, heat supply, air conditioning
Water supply; sewage and waste processing and sanitation Construction
Wholesale and retail; automotive and motorcycle repair Transportation and storage
Lodging and catering services Information and communications services
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Financial and insurance activities Real estate transactions

Professional, scientific and technical services Administration and services
State governance and defence; mandatory social insurance Education
Health and social care Art, entertainment and leisure
Other (please specify)

Bilderlings Pay Limited, 66 Prescot Street, London, E1 8NN, United Kingdom GB Page 1 of 4
Registration No. 9908958, Phone +44 203 936 8203, www.bilderlings.com
 CURRENT ACCOUNT APPLICATION FOR LEGAL ENTITIES
3.1 Detailed business description
Full description of the business such as: business organization structure, company’s website, how many directly/indirectly owned companies are involved in the business, how
customers are attracted, etc. Full information is needed to understand the business to ensure KYC principle at high quality level.

I confirm that the aforementioned business activities do not require a licence or special permit at the place of business
The aforementioned business activities require a license or special permit at the place of business and I attach a copy of the licence and/or special permit
License and/or special permit issuing country, authority:

License and/or special permit No. License and/or special permit issuing date
___ /___ / ______
dd mm yyyy
3.2 Is the company required to provide its financial statements to official authorities at the place of its registration or activities?
Yes No

4. AUTHORISED PERSON (-S) ACCORDING TO THE LEGAL DOCUMENTS

Authorised person 1 Authorised person 2 Authorised person 3 Authorised person 4

4.1 Name, Surname

4.2 Passport/ID card No.

4.3 Residence address
(Full address – street, city, postal code,
country)

4.4 Position in company

4.5 Politically exposed person (PEP) Yes No Yes No Yes No Yes No

4.6 U.S. person status Yes No Yes No Yes No Yes No
4.7 Mobile phone

4.8 E-mail

4.9 Use mentioned contacts for remote Yes No Yes No Yes No Yes No
access to account
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4.10 Voice password

4.11 Contact person (fill if different from authorised person) Name, Surname 4.11.1 Contact person position in the company

4.11.2 Contact phone 4.11.3 E-mail

Bilderlings Pay Limited, 66 Prescot Street, London, E1 8NN, United Kingdom GB Page 2 of 4
Registration No. 9908958, Phone +44 203 936 8203, www.bilderlings.com
 CURRENT ACCOUNT APPLICATION FOR LEGAL ENTITIES
5. INFORMATION ABOUT BENEFICIAL OWNER(S)

Please fill information about beneficial owner

(s) holding at least a 25% stake each Beneficial owner 1 Beneficial owner 2 Beneficial owner 3 Beneficial owner 4

5.1 Name, Surname

5.2 Passport/ID card No.

5.3 Residential and/or registered
address
(Full address – street, city, postal code,
country)

5.4 Tax residence country/Taxpayer

number
5.5 Sources of wealth or income Interest/dividends Interest/dividends Interest/dividends Interest/dividends
Property sale, rent Property sale, rent Property sale, rent Property sale, rent
Borrowing, heritage Borrowing, heritage Borrowing, heritage Borrowing, heritage
Salary/remuneration Salary/remuneration Salary/remuneration Salary/remuneration
Sale of shares/capital shares Sale of shares/capital shares Sale of shares/capital shares Sale of shares/capital shares
Other source (please specify) Other source (please specify) Other source (please specify) Other source (please specify)

5.6 Politically exposed person (PEP) Yes No Yes No Yes No Yes No

5.7 U.S. person status Yes No Yes No Yes No Yes No
5.8 Percentage of control (%) in the
commercial entity
5.9 Type of control direct via proxy direct via proxy direct via proxy direct via proxy
5.10 Contact phone

5.11 E-mail

6. FINANCIAL INFORMATION
6.1 Incoming payment sources:

Income from related companies that are included in a group of companies, holdings, etc.
Income from product/recipients/services buyers
Owner’s investments (specify sources of funds):
Loans (please provide agreements)
Other (please specify):
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6.2 Incoming payments

Full name of partner Country Brief description of the economic essence of planned transactions

Bilderlings Pay Limited, 66 Prescot Street, London, E1 8NN, United Kingdom GB Page 3 of 4
Registration No. 9908958, Phone +44 203 936 8203, www.bilderlings.com
 CURRENT ACCOUNT APPLICATION FOR LEGAL ENTITIES
6.3 Outgoing payments

Full name of partner Country Brief description of the economic essence of planned transactions

6.4 Estimated monthly turnover

Currency EUR

Planned maximum MONTHLY account Incoming payments

turnover
Outgoing payments

Planned maximum amount of a SINGLE Incoming payments

transaction
Outgoing payments

7. DECLARATION
An authorised person(s) of the company having signatory power should sign the declaration below. The application should then be sent to accounts@bilderlings.eu
By signing this Application Form, the Client confirms that all of the information provided in this Application Form is complete and true and the Client has read,
reviewed and agrees to BILDERLINGS PAY Terms and Conditions and Card Supplement and undertakes to comply with them. Client assumes full responsibility
for the transactions carried out with the cards by cardholder. The Client confirms that, prior to signing the Application Form, the Client has become acquainted
with BILDERLINGS PAY Pricelist and consents to its provisions. Terms and Conditions and Card Supplement are an integral part of this Application Form and by
signing this Application Form the Client expresses their will to enter into legal relationship with BILDERLINGS PAY. BILDERLINGS PAY may change their Terms and
Conditions and Card Supplement unilaterally at any time by giving the Client a prior notice. The new version of Terms and Conditions comes in force in the day set
by BILDERLINGS PAY.
By signing this Application Form, the Client agrees that BILDERLINGS PAY carries out processing of personal and other data in accordance with the General Data
Protection Regulation (GDPR) and other applicable laws and regulations.
According to GDPR, BILDERLINGS PAY carries out the processing of personal data of the Client, its representatives, authorised persons, representatives, beneficial
owners and other third parties related to the Client, including the collection, registration, input, storage, arranging, modification, using, transferring, transmission
and disclosure of data, blocking or deletion, and the Client is obliged to obtain consent to all data processing mentioned in this clause from all persons whose
personal data they have transferred to BILDERLINGS PAY.
The purpose of personal data processing is compliance with local and international laws and regulations, Client registration, the provision, offering and
maintenance of BILDERLINGS PAY products and services, the security of employees, the security of BILDERLINGS PAY property (assets), the performance of the
duties prescribed by law, and other legal interests of the BILDERLINGS PAY.
The Personal Data Processor is BILDERLINGS PAY.
The Client and BILDERLINGS PAY hereby agree that electronic mail (e-mail) may be used for exchanging information and documents. The Client represents that
he understands the risks inherent to use of e-mail, that BILDERLINGS PAY has informed about potential risks and explained their consequences, and that the
aforementioned information is understood by the Client.

8. AUTHORISED SIGNATORY

On behalf of the Client

Name, Surname Position Date
___ /___ / ______
dd mm yyyy
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Bilderlings Pay Limited, 66 Prescot Street, London, E1 8NN, United Kingdom GB Page 4 of 4
Registration No. 9908958, Phone +44 203 936 8203, www.bilderlings.com