Online Form Aplication Corporate

CUSTOMER IDENTIFICATION PROGRAM DISCLOSURE:

To help the government fight the funding of terrorism and money laundering activities, Federal Law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. What this means for you; When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We will also ask to see your passport, driver's license, or other identifying documents. All funds and assets contributed to this account are and will be beneficially owned by your corporate entity (“the Company”). The information given above is true and correct and any change in this information will be made in writing within thirty (30) days of such change to NextBank International Inc.

Select the type of product you are interested in applying for.

Account Type

Certificate of Deposit

Business Information

Name of Legal Entity *

Business Phone *

Street Address *

Apartment, suite, etc *

City *

State/Province *

ZIP / Postal Code *

Country *

Type of Entity (Select one that applies)

Registration No.

Year of Incorporation:

Number of Employees:

Gross Annual Sales:

Email Address *

Website

US Companies must have an EIN to open an account. All other businesses should have a tax identification number issued by their country of incorporation (a Foreign Tax Identification Number (FTIN)).

Employer Identification Number (EIN):

Foreign Tax Identification Number (FTIN)

No TIN Available (Explain):

Referral Source (One sentence description of who or how referred you to NextBank)

Explain Other:

Business Overview

Provide a detailed description of the business including products and services offered: *0 / 100

Is your business involved in any of the following? (Check all that apply)

a. Currency Exchange (including fiat currencies) *YesNo

b. Check cashing *YesNo

c. Issuer of Traveler's checks, money orders or stored value cards *YesNo

d. Seller or Redeemer of Traveler's checks, money orders, or stored value cards *YesNo

e. Money Transmitter *YesNo

f. Internet Gambling *YesNo

g. Consumer Lending *YesNo

e. If "NO" was selected in all of the above, check the box to the right *YesNo

If letter(s) a, b, c, or d was checked above, does your business engage in transactions greater than $1,000 for any person on any day in one or more transactions? *YesNo

If the answer to e or 3 was "Yes," your business is considered a Money Service Business. Is your business registered in any state as an MSB? *YesNo

If the answer to f was "Yes," please provide the following information along with this completed application: ▪ State or Tribal issued license that expressly authorizes your business to engage in internet gambling ▪ Signed commitment, disclosure on separate page, agreeing to notify the Bank of any changes in your legal authority to engage in Internet Gambling ▪ Third‐party certification that your systems for engaging in Internet Gambling are reasonably designed to remain within the licensed or otherwise lawful limits, including with respect to age and location.

If your business is considered a Money Service Business, indicate below the State (or Country if outside of the United States) in which your business is registered and provide a copy of the MSB registration. If your business in registered in multiple locations, use additional pages as necessary.

State *

Country *

Has your company been penalized, received a Consent Order or any other decree resulting from a disagreement with the Banking Division or Department in any state? *YesNo

Please provide details and a copy of any legal decree or opinion resulting from either any such judicial or non‐ judicial action.

Account Overview/Activity

Account Purpose *0 / 70

Expected Account Activity *0 / 70

Initial Deposit

Amount (USD) *

Bank Originator Name *

Name on Account *

Please Describe Other

Transfer To/From Other Banks *YesNoTransfers between this and customer’s accounts at other FIs

If yes, please describe.

Other Expected Account Activities (One required, check all that apply) *None Of The FollowingSales of Money Orders, Lottery Tickets Or GiftcardsWiretransfers, Currency Exchanges, Or Check Cashing For / On Behalf Of OthersService An Atm Or AtmsProcess Payments For Other BusinessesIf ‘yes’ to any of the following, please confer with the BSA Officer prior to account opening.

Expected Transactional Activity

Wire Transfers

Volume

Amount (USD: $)

Deposits

Withdrawals

If So, To/From Which Countries?

Authorized Signer Information

A legible copy of the Driver’s License must be provided (front/back) for each Authorized Signer.

Name *

Title *

Home Address (Street, City, Zip Code) *

Cellphone *

Email Address *

ID Type *

ID Number *

Issue Date if applicable

Expiration Date: *

Country of Citizenship *

DOB *

Transaction Account Disclosure Information

1. Have you had a transaction account at this or another financial institution within 12‐months before making this application? *YesNo

Have you had a transaction account closed by a financial institution without your consent within 12‐months before making this application? *YesNo

Have you been convicted of a criminal offense because of the use of a check or other similar items within 24 months of making this application? *YesNo

Politically Exposed Persons

Do you have any relatives or close associates in Foreign Government? *YesNoA politically exposed person (PEP) is defined by the Financial Action Task Force (FATF) as an individual who is or has been entrusted with a prominent public function. Due to their position and influence, it is recognized that many PEPs are in positions that potentially can be abused for the purpose of committing money laundering (ML) offences and related predicate offences, including corruption and bribery, as well as conducting activity related to terrorist financing (TF). This has been confirmed by analysis and case studies. The potential risks associated with PEPs justify the application of additional anti-money laundering/counter-terrorist financing (AML/CFT) preventive measures with respect to business relationships with PEPs.

History Of Legal Proceedings

If the response to any of the questions in F (1‐5) was "Yes," provide additional information as to the date, persons involved, and circumstances.

Has the applicant, its affiliates, any member of senior management, directors or owners of the company been convicted of a criminal offense? *YesNo

Has the applicant, its affiliates, any member of senior management, directors or owners of the company been subject to a deferred prosecution agreement? *YesNo

Has the applicant, its affiliates, any member of senior management, directors or owners of the company been subject to a non‐prosecution agreement? *YesNo

Has the applicant, its affiliates, any member of senior management, directors or owners of the company been subject to a non‐adjudicated resolution? *YesNo

Has the applicant, its affiliates, any member of senior management, directors or owners of the company been involved in either a civil or criminal forfeiture? *YesNo

Signatures

Authorized Signature

Title

Date

Officers, Control Persons, Ultimate Beneficial Owners

Note: Beneficial owners owning 25% or greater of the entity. A copy of a valid photo ID is required for all listed. Ownership: Please supply the following information for each individual, if any, who, directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, owns 25% or more of the equity interests of the legal entity listed above. Note: If 25% or more of the ultimate beneficial ownership breaks down to an excluded entity (e.g., publicly traded company), note the name of the excluded entity below.. Control: In addition to ownership, please specify at least one individual with significant responsibility for managing the legal entity listed above (i.e., Control Person box must be checked for at least one individual). An individual with significant responsibility for managing the legal entity may be:  An Executive Officer or Senior Manager (e.g., Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, Managing Member, General Partner, President, Vice President, Treasurer, etc.); OR  Any other individual who regularly performs similar functions.

Name *

Title/Role *

% Ownership *

Home Address (Street, City, Zip Code) *

Social Security Number (if applicable)