Due Diligence Form

Full name: *

As on Passport/Any Government issued Identification document (National Identity card, Driver’s license)

Mobile number: *

Include country code e.g +234 for Nigeria, +237 for Cameroon etc

Nationality: *

Permanent address: *

Address Line 1

City

State / Province / Region

Postal Code

Country

Enter 0 if you don't have a postal code.

Business details and nature of business:

Do you own a business? *

Yes
No

Is the business duly registered? *

Yes
No

Briefly explain the nature of your business: *

Is your business the sole source of the funds you transfer across Swychr’s network? *

Yes
No

How often do you intend to use Swychr to transfer value (funds)? *

What is your estimated daily transfer volume across Swychr network in Purple Coins (take note Swychr may impose transfer and withdrawal limits subject to capacity and regulations)? *

Checkboxes *

By completing and signing on this form, you agree that all the information provided herein are both complete and accurate. You also confirm that you will not be using Swychr to transfer funds for any other reasons especially not for financing terrorist activities, money laundering or any other illegal activities.

Date: *

Signature: *

Sign on the space above. Use the " x " at the top right of this signature box to clear and resign if you make a mistake.