CEX Application Form 1.0
CEX Application Form 1.0
CEX Application Form 1.0
"/%"(3&&.&/5'03.
Ņ
Section 1
Date:
1FSTPOBMJOGPSNBUJPO
. Full name:
. ID number:
Driver
. ID type: Passport ID card
licence
. ID dates (DD/MM/YYYY)
. Home SFTJEFOUJBM
address:
11.1 Facebook:
11.2 LinkedIn:
11.3 Other:
SIGN______________________________________
Section 2
&NQMPZNFOU
3. Employer address:
7. Employer website:
6. How long have
you been employed: years
SIGN______________________________________
Section 3
4PVSDFPGGVOET
! Please provide any financial documentation to support your statement with your reply.
Mined Bought
If bought, where:
SIGN______________________________________
Section 4
1BZNFOUEFUBJMT
Please, provide us information about your bank which you intend to use to make
deposits and withdrawals:
*Yes No
*If you checked 'Yes', please tell us, whether you intend
to make deposits for amount above
1,000 USD/EUR per day?
**Yes No
SIGN______________________________________
Section 5
2VFTUJPOOBJSF
3. What is the estimated amount that you are planning turnover on CEX.IO account per month?
4. Are you a Politically Exposed Person (PEP)? 5. Are you a family member or a close associate
of PEP?
Yes No Yes No
If yes, describe your position: If yes, describe your relationship and his/her position:
SIGN______________________________________
Section 6
%FDMBSBUJPO
I hereby certify that the information provided in this application form is true and accurate.
I agree that if the application approved I will be bound by CEX.IO Terms of Use (https://cex.io/terms) and all
applicable policies, limits and conditions and will not use the CEX.IO service to commit a fraud or violate any
laws.
I authorise CEX.IO LTD to use, process and keep all information it obtains from me for auditing, risk assessment,
fraud and crime prevention measures.
I undertake to inform CEX.IO in writing of any changes in the information provided herein and I agree to
provide CEX.IO documents that prove the source of my funds upon reasonable request.
SIGNED BY Name:
Date: