Moneybase Business Application Form

1. Moneybase Business Plan
Please select your Moneybase Business plan*
Visit www.moneybase.com/business for details
Please select payment frequency*
Choose to pay annually or monthly
Did you speak to
2. Company details
Company or Trading name*
Country of tax residence*
Company legal form*
Tax number*
TIN
LEI code (optional)
This is required to make use of Investment Services
Phone number*

Country codePhone number
Company registration number*
Company email*
VAT number*
Company website
Registered address*

Address line 1

Address line 2

Town / cityState / Province

PostcodeCountry
Is the registered address the same as operating address?

Yes
Operating address

Address line 1

Address line 2

Town / cityState / Province

PostcodeCountry

2. Company details

Continued...
Description of business activities*
Business sector*
Are you listed on a stock exchange or regulated by a financial regulator?*
Does your entity's constitutional documents allow the issuance of bearer shares?*
Are any of the entity's shares held in fiduciary capacity?*
Last 12 months revenue (€)*
Source of Wealth*
If Source of Wealth is 'Other', please specify
Main purpose of account*
Number of employees*
Total number of Directors and UBOs owning more than 25%*

3. Expected incoming activity
Value of monthly incoming bank transfers*
Number of monthly incoming bank transfers*
Principle country for incoming bank transfers*
Secondary country for incoming bank transfers*
4. Expected outgoing activity
Value of monthly outgoing bank transfers?*
Number of monthly outgoing bank transfers*
Principle country for outgoing bank transfers*
Secondary country for outgoing bank transfers *

5.1 Details of Director / UBO / Sole Trader
Full name*

First nameLast name
Is this person a UBO, Director, Sole trader?*
Role / occupation*
Date of birth*

DayMonthYear
Nationality*
Dual nationality (if applicable)
Tax residency country*
Email address*
Email should be using a company domain
Phone number*

Country codePhone number
Residential address*

Address line 1

Address line 2

Town / cityState / Province

PostcodeCountry
Have you acquired any citizenship through an Investment Programme? (eg IIP)*
Are you a US citizen?*
Are you a PEP or relative to a PEP?*
Source of Wealth*
If Source of Wealth is ‘Other’, please specify

5.2 Director / UBO
Full name*

First nameLast name
Is this a UBO, Director or both?*
Role / occupation*
Date of birth*

DayMonthYear
Nationality*
Dual nationality (if applicable)
Tax residency country*
Email address*
Email should be using a company domain
Phone number*

Country codePhone number
Residential address*

Address line 1

Address line 2

Town / cityState / Province

PostcodeCountry
Have you acquired any citizenship through an Investment Programme? (eg IIP)*
Are you a US citizen?*
Are you a PEP or relative to a PEP?*
Source of Wealth*
If Source of Wealth is ‘Other’, please specify

5.3 Director / UBO
Full name*

First nameLast name
Is this a UBO, Director or both?*
Role / occupation*
Date of birth*

DayMonthYear
Nationality*
Dual nationality (if applicable)
Tax residency country*
Email address*
Email should be using a company domain
Phone number*

Country codePhone number
Residential address*

Address line 1

Address line 2

Town / cityState / Province

PostcodeCountry
Have you acquired any citizenship through an Investment Programme? (eg IIP)*
Are you a US citizen?*
Are you a PEP or relative to a PEP?*
Source of Wealth*
If Source of Wealth is ‘Other’, please specify

5.4 Director / UBO
Full name*

First nameLast name
Is this a UBO, Director or both?*
Role / occupation*
Date of birth*

DayMonthYear
Nationality*
Dual nationality (if applicable)
Tax residency country*
Email address*
Email should be using a company domain
Phone number*

Country codePhone number
Residential address*

Address line 1

Address line 2

Town / cityState / Province

PostcodeCountry
Have you acquired any citizenship through an Investment Programme? (eg IIP)*
Are you a US citizen?*
Are you a PEP or relative to a PEP?*
Source of Wealth*
If Source of Wealth is ‘Other’, please specify

5.5 Director / UBO
Full name*

First nameLast name
Is this a UBO, Director or both?*
Role / occupation*
Date of birth*

DayMonthYear
Nationality*
Dual nationality (if applicable)
Tax residency country*
Email address*
Email should be using a company domain
Phone number*

Country codePhone number
Residential address*

Address line 1

Address line 2

Town / cityState / Province

PostcodeCountry
Have you acquired any citizenship through an Investment Programme? (eg IIP)*
Are you a US citizen?*
Are you a PEP or relative to a PEP?*
Source of Wealth*
If Source of Wealth is ‘Other’, please specify

5.6 Director / UBO
Full name*

First nameLast name
Is this a UBO, Director or both?*
Role / occupation*
Date of birth*

DayMonthYear
Nationality*
Dual nationality (if applicable)
Tax residency country*
Email address*
Email should be using a company domain
Phone number*

Country codePhone number
Residential address*

Address line 1

Address line 2

Town / cityState / Province

PostcodeCountry
Have you acquired any citizenship through an Investment Programme? (eg IIP)*
Are you a US citizen?*
Are you a PEP or relative to a PEP?*
Source of Wealth*
If Source of Wealth is ‘Other’, please specify

5.7 Director / UBO
Full name*

First nameLast name
Is this a UBO, Director or both?*
Role / occupation*
Date of birth*

DayMonthYear
Nationality*
Dual nationality (if applicable)
Tax residency country*
Email address*
Email should be using a company domain
Phone number*

Country codePhone number
Residential address*

Address line 1

Address line 2

Town / cityState / Province

PostcodeCountry
Have you acquired any citizenship through an Investment Programme? (eg IIP)*
Are you a US citizen?*
Are you a PEP or relative to a PEP?*
Source of Wealth*
If Source of Wealth is ‘Other’, please specify

5.8 Director / UBO
Full name*

First nameLast name
Is this a UBO, Director or both?*
Role / occupation*
Date of birth*

DayMonthYear
Nationality*
Dual nationality (if applicable)
Tax residency country*
Email address*
Email should be using a company domain
Phone number*

Country codePhone number
Residential address*

Address line 1

Address line 2

Town / cityState / Province

PostcodeCountry
Have you acquired any citizenship through an Investment Programme? (eg IIP)*
Are you a US citizen?*
Are you a PEP or relative to a PEP?*
Source of Wealth*
If Source of Wealth is ‘Other’, please specify

6. Users setup

Define the users who will have online access to the Moneybase Business Portal
How many users do you want to setup on this account?*

7.4 User registration details
Full name*

First nameLast name
Date of birth*

DayMonthYear
Document type
Identity document number*
Email address (corporate)*
Phone number*

Country codePhone number
Position held within the company*
Address*

Address line 1