Legal Name of Entity
Doing Business As (DBA)
Website Address (if relevant)
Entity's Firm Type (LLC, LTD, PLC, IRA,
etc)
Please provide a detailed description of your
entity's business
activities
(including industry, services provided, typical customer profile,
jurisdictions of
operation,
nature of payments accepted, etc.)
Country of incorporation, formation or
organization
State of Incorporation
Registered Address
Physical Location Address (if different than
above)
Jurisdiction of tax residency (if different
from the
country of
incorporation etc. stated above)
Tax Identification Number - For U.S. entities: TIN or
EIN; For non-U.S.
entities: TIN. If the jurisdiction does not issue TINs – please explain and
provide a
registration number.
Does the company have any pending litigation,
disputed accounts or
other
unresolved matters in any country or territory?
If yes, Please provide a description:
Is your entity regulated or licensed by any
authority? If yes, please elaborate
Please provide all company directors (if any new
directors please provide their ID and proof of address).
Full Name
Email
Phone Number
Date of Birth
Nationality
ID Number
Residential Address
List of Beneficiaries. Please scroll to
complete all
fields (at least one is required)
Full Name
Percented Own of Company
Title
Email
Phone Number
Date of Birth
Nationality
ID Number
Residential Address
Primary Account Manager for the Celsius account.
Please scroll to
complete all
fields(if different than above)
Full Name
Email
Phone Number
Date of Birth
Nationality
ID Number
Residential Address
