Individuals

Individuals
Applicant Legal Name*
Date of Birth*

MonthDayYear
Country of Citizenship*
Please enter your Social Security Number*
If you are a non-US resident, please enter your country's foreign identification number (EX. SIN)
Cell phone*
Email address*

Is the applicant or any of its authorized controllers a politically exposed person ("PEP)?*

YesNo
Provide us with a further exploration*
Has the applicant or any authorized individual been convicted of a crime?*

YesNo
Provide us with a further exploration*
Passport Information
Passport number:*
Place of issue*
Date of issue*

MonthDayYear
Applicant's Occupation*

Trading Information
What is the intended use of your account with Stillman Digital?*
Please provide us as much detail as possible. Ie. What is the purpose of the trades? Reason for opening an account?
What pairings are you looking to trade?*
What is the planned size of your first initial deposit?*
What is the expected average monthly volume in national USD?*
Please provide detail on the source of funding that will be used to trade with Stillman Digital*
Ie. Where are the deposited funds coming from?

Bank Wire & Digital Asset Information
Name on Bank Account:*
Account number:*
Beneficiary Address:*
Routing Number:*
Bank Name:*
SWIFT Code:*
Bank Address:*
Are you receiving funds into a bank account that is located outside of the U.S.?*

YesNo
Intermediary / Correspondent Bank Name:*
Intermediary / Correspondo Routing Number:*
Intermediary / Correspondent Bank Address:*
Wallet Whitelisting

Note: please add at least 1 wallet for whitelisting, you will not be approved without providing your wallets.
BTC Address:
ETH / ERC-20 Address:
Tron / TRC20 Address:

Additional Authorized Controller

Please provide us with information on all additional authorized controller persons having access to this account. All additional authorized controllers will need to submit the same documentation as the account holder. If you would like to give authority to someone else to make trades on your behalf, you must fill in this section.
Controller Legal Name:
Country of Citizenship
Please enter your Social Security Number:
If you are a non-US resident, please enter your country's foreign identification number (EX. SIN)
Date of Birth

MonthDayYear
Individuals Registered Address:
Address indicated here should match the address indicated on the uploaded bank statement.
Cell Phone
Email Address:
Passport Number:
Passport Place of Issue:
Passport Date of Issue:

MonthDayYear
Relationship to Account Number:

Passport Information