KYC Company - Jelvix

Company Form

The questionnaire has to be filled in and submitted in English ONLY

CUSTOMER’S GENERAL INFORMATION

Company Name: (as it appears on the Certificate of Incorporation or equivalent documents)

Company is:

Private

Public

Government-owned

REGISTRATION DETAILS

Number:

Date:

VAT Number: Please enter your VAT Number

Main business activities:

Number of years in operation:

Number of employees:

Number and location of branches (including representative offices):

REGISTERED ADDRESS

Number and street:

City:

State (for US):

Postal Code:

PHYSICAL ADDRESS

Physical Address is the same as Registered Address.

Number and street:

City:

State (for US):

Postal Code:

CONTACT DETAILS

Phone: Please enter your Phone

Email: Please enter valid email address

Mobile:

Skype ID:

Fax:

Web Address:

REPRESENTATIVE’S (SIGNATORIES) INFORMATION

#1

Name:

Position:

Date of Birth:

Contact information (phone/email/etc):

Attach signature example

FINANCIAL INFORMATION

Preferable payment currency:

USD

Euro

Pounds

Other

REQUESTED SERVICES

Consulting

Project management

Development

Dedicated Development Team

Other

Specification

UI/UX

Technical Support

DOCUMENTS

Please make sure that you enclose the following documents and information and check the boxes accordingly:

Certificate of Incorporation or Articles of Association

Memorandum of Association (or similar)

Company register extract

Appointment of Director (or similar)

Information on the legal address of the registered office

The minutes or the resolution of the management board (director) / or power of attorney, or other legal authorization documents in respect of the person who is authorized to execute the Master Agreement on behalf of the company

Attach signature example

OTHER INFORMATION

Please feel free to provide us with any additional information that you believe might be helpful for our cooperation: Please enter from 25 to 500 characters

Name:

Position:

Date:

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

New Customer Questionnaire

Company Form

CUSTOMER’S GENERAL INFORMATION

REGISTRATION DETAILS

REGISTERED ADDRESS

PHYSICAL ADDRESS

CONTACT DETAILS

REPRESENTATIVE’S (SIGNATORIES) INFORMATION

#1

FINANCIAL INFORMATION

REQUESTED SERVICES

DOCUMENTS

OTHER INFORMATION

Thank you for your application!