DBFI Whitelisting

1

Enter Mobile No* This field is required.Please provide and confirm your valid mobile number

2

Full Name* This field is required.Enter your full name sama as your ID

Prefix

First Name

Last Name

3

Email Address* This field is required.Please enter valid email address

example@example.com

Email Verified

The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification

••••

4

Company NameEnter company name for company participation.

eg. abc ltd (optional)

5

Expected Pre-ICO/ICO amount* This field is required.Expected amount information is to help us estimate total volume and does not reflect to your amount at the time of sale. If you expected participation amount is morethan 20 ETH, you may be subject to providing proof of residence and further KYC documents.

eg. 1000 tokens

6

Crypto wallet addressEnsure your Ethereum ERC-20 compatible wallet is correct as DBFI tokens will be sent to this address. please Copy you wallet address and paste here.

eg. if no wallet - download Metamask and create wallet (or leave blank). token will be stored on Trustlane Portal

8

Type of Payment* This field is required.Please tell us mode of your payment

Bank Transfer

Debit/Credit Cards

Bitcoin

Ethereum

9

Please Select Country Origin* This field is required.Trustlane llc not available to the countries where they not allowed.

10

Upload Your ID* This field is required.Please upload valid ID/Passport ( JPG,PNG,PDF)

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

11

Referral NameEnter referral name if any ( optional)

12

Name of BeneficiaryEnter your beneficiary name just in case you unable to be contacted

eg. Son, wife, nephew .etc (optional)

13

Beneficiary ID/Passport No.

Enter beneficiary ID/Passport No. (optional)

14

Participation Terms Conditions* This field is required.Please read carefully the following terms

15

Please verify that you are human* This field is required.Tick to continue

16

Signature* This field is required.Drag your stylus or finger to sign

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17

Please review your detail and confirm your submissionYour IP and location has been recorded as follow.