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Partner Application Form
It will take a couple of minutes to fill in the data. We will contact you once you're done
with the submission. All your progress is saved in each stage of the form.
It will take a couple of minutes to fill in the data. We will contact you once you're done
with the submission. All your progress is saved in each stage of the form.
OTP Verification
Enter the 6 number code sent to:
Code valid for: 14:59
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Partner Application Form
SECTION I · Company Information.
It will take a couple of minutes to fill in the data. We will contact you once you're done
with the submission. All your progress is saved in each stage of the form.
Legal Name of Entity *
This field is required.
Business ID # *
This field is required.
Legal Entity Type *
This field is required.
DBA (if different that legal name):
Industry *
This field is required.
Website Address *
Enter a valid URL (e.g. https://example.com).
Primary Phone # *
Enter a valid phone number.
Business Email *
Enter a valid email address.
Country *
This field is required.
Date of Formation *
Please select a valid date.
Business Physical Address *
This field is required.
Mailing Address (if different)
Does the Company belong to a group? *
Please select an option.
Group Structure Details *
Please enter at least 15 characters.
Partner Application Form
SECTION I · Company Information.
It will take a couple of minutes to fill in the data. We will contact you once you're done
with the submission. All your progress is saved in each stage of the form.
Company Representative(s) *
No representatives added yet. Click "Add Representative" to begin.
Add at least one company
representative.
Tell us about your business *
Nature of your business *
This field is required.
Products and/or services that you offer *
This field is required.
Locations where you operate *
This field is required.
Do you need a license for your business? *
Please select an option.
Partner Application Form
SECTION II · Initiative Overview.
It will take a couple of minutes to fill in the data. We will contact you once you're done
with the submission. All your progress is saved in each stage of the form.
Who are the intended customers that you wish to onboard? (Ex. Employees for payroll) *
Please enter at least 15 characters.
Location of customers (Provide countries, specific states/locales if applicable) *
This field is required.
Technical Contact for Integration *
Name *
This field is required.
E-mail *
Enter a valid email address.
Phone *
Enter a valid phone number.
Partner Application Form
SECTION III · KYC Information.
It will take a couple of minutes to fill in the data. We will contact you once you're done
with the submission. All your progress is saved in each stage of the form.
What is the company's yearly revenue? *
Please select a revenue range.
What is the company's total net assets? *
Please select a net assets range.
What is the company's detailed source of funds? *
Please enter at least 15 characters.
Is any of the involved persons in the company considered as a PEP? *
Please select an option.
Is the company a regulated financial intermediary? *
Please select an option.
Partner Application Form
SECTION IV · Transactional & Settlement Details.
It will take a couple of minutes to fill in the data. We will contact you once you're done
with the submission. All your progress is saved in each stage of the form.
Description
Month 1 *
Month 6 *
Month 12 *
Month 24 *
Projected Cards
Projected Volume
Projected Transactions
Total
0
0
0
0
Please fill in all fields with
positive numbers.
Partner Application Form
SECTION V · Beneficial Owner(s) information.
It will take a couple of minutes to fill in the data. We will contact you once you're done
with the submission. All your progress is saved in each stage of the form.
Is the company considered
an operative active company or a domiciliary company? (please tick the respective box) *
Please select an option.
This distinction helps us to assess the economic background of the company and to determine the
appropriate level of due diligence.
SECTION V.1 Ultimate Beneficial Owner(s) of operating
legal entities and Partnerships
The authorized representative of the company
hereby declares that (tick the appropriate box):
Please select an option.
SECTION V.2 Ultimate Beneficial Owner(s) of
domiciliary company
The authorized representative of the company hereby declares that the person(s) listed below is/are the
beneficial owner(s) of the assets involved in the business relationship. If the contracting partner is
also the sole beneficial owner of the assets, the contracting partner's detail must be set out below.
#
Name *
Date Of Birth *
Nationality *
Domicile Country *
No rows added yet.
Please add at least one beneficial
owner.
Partner Application Form
SECTION V.1 · Beneficial Owner(s) information.
It will take a couple of minutes to fill in the data. We will contact you once you're done
with the submission. All your progress is saved in each stage of the form.
Layer 1:Natural Persons / Legal
Entity Shareholders who have an ownership stake in your company
#
Company (Y/N)
Name/Company Name *
Residential Address / Registered Address *
Direct Ownership (Shares %) *
Direct Ownership (Voting Rights %) *
Shares total: 0% | Voting Rights total: 0%
No rows added yet.
Please add at least one entry for
Layer 1.
Layer 2:Natural Persons / Legal
Entity Shareholders who have an ownership stake in layer 1 company
#
Company (Y/N)
Name/Company Name *
Residential Address / Registered Address *
Direct Ownership (Shares %) *
Direct Ownership (Voting Rights %) *
Shares total: 0% | Voting Rights total: 0%
No rows added yet.
Please add at least one entry for
Layer 2.
Layer 3:Natural Persons / Legal
Entity Shareholders who have an ownership stake in layer 2 company
#
Company (Y/N)
Name/Company Name *
Residential Address / Registered Address *
Direct Ownership (Shares %) *
Direct Ownership (Voting Rights %) *
Shares total: 0% | Voting Rights total: 0%
No rows added yet.
Please add at least one entry for
Layer 3.
Partner Application Form
SECTION VI · Upload Documents.
Please provide the following documents.
Commercial Register extract *
(issued within the last 12 months)
Upload pending
Click to add file here
Please upload this document.
Articles of Association *
Upload pending
Click to add file here
Please upload this document.
Certificate of Good Standing (if applicable)
Upload pending
Click to add file here
Shareholder register *
Upload pending
Click to add file here
Please upload this document.
List of directors and authorized signatories *
Upload pending
Click to add file here
Please upload this document.
Screenshot of regulator's website with information of the legal entity
*
Upload pending
Click to add file here
Please upload this document.
Identification document of all shareholders owning 25% or more *
Upload pending
Click to add file here
Please upload this document.
License Approval Letter *
Upload pending
Click to add file here
Please upload the license approval letter.
At least one of the following:
Recent bank statements
Upload pending
Click to add file here
Financial statements or equivalent supporting documents
Upload pending
Click to add file here
Please upload at least one of
the optional documents (bank statements or financial statements).
PARTNER APPLICATION FORM
The authorized representative hereby undertakes to automatically inform Unblock of any changes to the
information contained herein.
It is a criminal offence to deliberately provide false information on this form (article 251 of
the Swiss Criminal Code, document forgery)
