OTC Application Form

1. Contact Details

1.1 Title *
---Mr.Mrs.Miss.Ms.Dr.Sir.Madame.Prefer not to say
1.2 Full Name *

1.3 Preferred Name

1.4 Job Title *

1.5 Contact number *

1.6 Email address *

1.7 Who has been your primary contact(s) at Ibanera? *

2. Corporate Information

2.1 Entity legal name *

2.2 Entity trading name (if different to legal name)

2.3 Company Registration Number *

2.4 Country of Incorporation *

2.5 Registered address with Company Registry (Including Postcode) *

2.6 Operating address, if different from the registered company address (PO Boxes not accepted) (Including Postcode)

2.7 Are there any additional countries in which you operate? *
---NoYes
2.8 Type of Business *

2.9 Provide a detailed description of your business *

2.10 Website *

2.11 Social media platforms (Twitter, LinkedIn, Facebook, others)
FacebookLinkedInTwitterOther
2.12 Please upload the Certificate of Incorporation (or equivalent) *

2.13 Please upload Certificate of Incumbency or Certificate of Good Standing *

2.14 Please upload constitutional documents/Memorandum & Articles of Association (or equivalent) *

2.15 Please upload your corporate structure chart showing all entities within your group structure which must include the natural person(s) who are the ultimate beneficial owner(s). *

2.16 Is the entity applying or the group parent listed on any stock exchange? If yes, please provide the exchange and ticker. *
---NoYes

2.17 Is the applying entity part of a group or does it rely on financial support from a group entity? *
---NoYes
2.18 Please upload a copy of your most recent full-year Annual Report and Audited Financial Accounts for the entity applying (including Balance Sheet and Income Statement). You can upload multiple files. *

2.19 If the accounts uploaded in 2.18 (above) are older than 15 months, please upload your management accounts to the most recent balance date, and year to date management accounts. You can upload multiple files.

2.20 Please upload the Board Resolution authorising the opening of the account with Ibanera.*

2.21 Are you required to be regulated by any National Competent Authority or registered with any Financial Intelligence Unit in your registered or operating jurisdiction? *
---NoYes

3. Owners and Controllers

We are required to identify and verify the natural persons who are the controllers (Directors/Partners etc...), Authorized Signatories and owners of your organization.

3.1 Please either upload your Register of Directors (or equivalent), or list the company's Directors details in the boxes below. *


3.2 Please provide a certified proof of Identity and a permanent residential address for at least two directors listed above. *

These should be:
(1) Certified copy of a government-issued ID document, (e.g. a valid passport or driving licence)
(2) Proof of address in the form of a household utility bill (e.g. gas, electricity, water, landline or broadband only), a tax bill, or a bank statement dated within the last three months. Please note we cannot accept mobile phone bills.

3.3 Please either upload your list of Authorised Signatories, or list their details in the boxes below.

You will need specify if these signatories will have single or joint signing authority. (If no specification is made, the signing authority will be assumed as a single signing authority). *


3.4 Please provide a certified proof of Identity and a permanent residential address for all the signatories listed above. *

These should be:
(1) Certified copy of a government-issued ID document, (e.g. a valid passport or driving licence)
(2) Proof of address in the form of a household utility bill (e.g. gas, electricity, water, landline or broadband only), a tax bill, or a bank statement dated within the last three months. Please note we cannot accept mobile phone bills.

3.5 Please either upload your list of any natural persons, either owning or controlling (directly or indirectly) more than 10% of the issued shares, voting rights or ownership interest. *

3.6 If another corporate body holds greater than 10% of the issued shares within your group structure, please provide its Incorporation Documents, Register of Directors and Register of Members.

3.7 Please provide a certified proof of Identity and a permanent residential address for all the shareholders. *

These should be:
(1) Certified copy of a government-issued ID document, (e.g. a valid passport or driving licence)
(2) Proof of address in the form of a household utility bill (e.g. gas, electricity, water, landline or broadband only), a tax bill, or a bank statement dated within the last three months. Please note we cannot accept mobile phone bills.

4. Transactional Information

4.1 Please detail the classification of your underlying clients and any proprietary trading you do by percentage. *



4.2 Please detail the jurisdiction of your underlying clients by percentage, including the proprietary trading you may undertake. *









4.3 Will you be redistributing our prices to your underlying clients? *
---NoYes
4.4 Please outline your current liquidity providers *

4.5 Please provide a copy of your KYC/AML Manual *

4.6 Do you use third-party tools to screen your underlying client's against adverse media, PEPs and sanctions? If yes, please name of provider and frequency of screening. *
---NoYes

4.7 Do you use third-party tools to screen your underlying client's transactions to monitor suspicious activity? If yes, please name of provider and frequency of screening. *
---NoYes

4.8 Do you have a list of prohibited jurisdictions from which you will not onboard an underlying client (i.e. countries that are subject to comprehensive sanctions or countries that have weak AML controls)? *
---NoYes
4.9 Do you have a list of prohibited client types (i.e. shell banks, arms dealers, sanctioned entities)? *
---NoYes
4.10 Do you have a list of prohibited transaction types (i.e. mixers etc...)? *
---NoYes
4.11 Please provide your cash SSI’s (Fiat banking instructions)*

4.13 Please complete the below table. (Please note that Ibanera does not process third party payments or receipts. Ibanera will not process transactions to or from exchanges etc.) You must own and control your wallet infrastructure. *

4.14 Source of Wealth – please describe in as much detail as possible how the beneficial owner(s) acquired their total wealth. *

4.15 Source of Funds – Please describe the origin of the funds involved in the business relationship with Ibanera *

4.16 Source of Coin – please describe the origin of the cryptocurrencies involved in the business relationship with Ibanera. *

Ibanera Products

Which products would you like to engage in with Ibanera? You can select more than one. *
Trading (Spot or CFD)Client Loans (Lending to Ibanera)Term Loans (Borrowing from Ibanera)

5. Trading with Ibanera

5.1 What is the total notional trading limit you require? (USD) *

5.2 Which cryptocurrencies would you like to trade? *
BTCMajor Altcoins: BCH, ETH, LTC, XRPOther Altcoins: DOT, EOS, LNK, XLMStablecoins: USDC, USDTOther
5.3 Against which fiat currencies would you like to trade? *
Major: EUR, CHF, GBP, JPY, & USDMinor: AUD, CAD, CNH, MXN & SGD
5.4 Anticipated Trading Activity *

5.5 Do you require Contracts for Difference ("CFDs")?*

Please note: CFD transactions carry a higher degree of risk than entering into spot transactions and may not be suitable for every customer. You may need to provide evidence of your understanding of this product including but not limited to knowledge, transactional history, size of financial instrument portfolio. This product is only available to eligible counterparties and professional investors only (as defined by the Financial Conduct Authority) and not retail customers.

This product is not currently avaliable for US Persons.

If you request this product, we will contact you under separate cover to inform you of any additional requirements. *
---NoYes

6. Lending to Ibanera

6.1 Which digital and/or fiat currencies would you like to lend to Ibanera? *
BTCMajor Altcoins: BCH, ETH, LTC, XRPOther Altcoins: DOT, EOS, LNK, XLMStablecoins: USDC, USDTMajor Fiat: EUR, CHF, GDBP, JPY & USDMinor Fiat: AUD, CAD, CNH, MXN & SGDOther
6.2 What would be the average tenor of a loan? *
7 days (minimum)7 days - 4 weeks4 weeks - 2 months2 months - 3 months3 months - 6 months6 months - 12 months1 year - 3 yearsCustom tenor
6.3 What is the maximum notional amount you are likely to have available to lend to Ibanera? (USD equivalent) *
50,000 - 500,000500,001 - 1,000,0001,000,001 - 5,000,0005,000,001 - 10,000,000> 10,000,000Other

7. Borrowing from Ibanera

7.1 What is the purpose for seeking a borrowing facility with Ibanera? *

7.2 What is the maximum borrowing exposure you require? (USD equivalent) *

7.3 Which digital and/or fiat currencies would you like to borrow from Ibanera? *
BTCMajor Altcoins: BCH, ETH, LTC, XRPOther Altcoins: DOT, EOS, LNK, XLMStablecoins: USDC, USDTMajor Fiat: EUR, CHF, GDBP, JPY & USDMinor Fiat: AUD, CAD, CNH, MXN & SGDOther
7.4 Which digital and/or fiat currencies can you offer as collateral? *
BTCMajor Altcoins: BCH, ETH, LTC, XRPOther Altcoins: DOT, EOS, LNK, XLMStablecoins: USDC, USDTMajor Fiat: EUR, CHF, GDBP, JPY & USDMinor Fiat: AUD, CAD, CNH, MXN & SGDOther
7.5 What would be the average tenor of a loan? *
7 days (minimum)7 days - 4 weeks4 weeks - 2 months2 months - 3 months3 months - 6 months6 months - 12 months1 year - 3 yearsCustom tenor
7.6 If required, would you be willing to provide a guarantee from another entity in the group? *
---NoYes
7.7 Do you have any outstanding debt facilities? Including traditional, digital and group debt. *
---NoYes
7.8 Are there any other key credit terms you are seeking that have not already been covered? *

8. Authorised Users and Key Personnel

8.1 Please complete the below table for Key Personnel

8.2 Do you have a list with all the Authorised Traders and Authorised Users? *
---NoYes

9. Declaration and Signature

9.1 I declare that no person listed above is classified as a PEP, not a family member or close associate of a PEP.

i. PEPs are defined as individuals entrusted with prominent public functions such as heads of state, heads of government, ministers and deputy or assistant ministers, members of parliament or of similar legislative bodies (e.g. regional governments in federalised systems and devolved administrations where such bodies have some form of executive decision-making powers, members of the governing bodies of political parties, members of supreme courts, of constitutional courts or of any judicial body the decisions of which are not subject to further appeal except in exceptional circumstances, members of courts of auditors or the boards of central banks, ambassadors, charge d’affaires and high-ranking officers in the armed forces (Permanent Secretary/Deputy Permanent Secretary level or hold equivalent military rank (e.g. Vice Admiral, Lieutenant General, Air Marshal or senior), members of the administrative, management or supervisory bodies of State-owned enterprises (this only applies where the state has ownership of greater than 50% or where information reasonable available points to the state having control over the activities of such enterprises, directors, deputy directors and members of the board or equivalent function of an international organisation (the UN and NATO).

ii. Family members of a PEP include, spouse, or civil partner, children and their spouses or civil partner, parents, and siblings. Close associates of a PEP includes, an individual known to have joint beneficial ownership of a legal entity or a legal arrangement or any other close business relationship with a PEP or an individual who has sole beneficial ownership of a legal entity or a legal arrangement that is known to have been set up for the benefit of a PEP. *

We will use the information provided to process your application for an account with Ibanera which will include searches of external third-party reference sources in order to meet our legal requirements. If your application is successful, we will also use this information to maintain your relationship with us and provide the services which you have requested.

10.1 We will not use your data, without your express permission, for marketing or any other purposes. Should you wish to receive marketing from Ibanera will mark below

10.2 I declare on behalf of the Firm applying that the funds used in the relationship with Ibanera are (i) of legal origin and therefore not derived from illicit activity and (ii) fully tax compliant according to the laws and regulations applicable in the Firm's country of incorporation. *

10.3 Please upload the Board Resolution, any other documents requested in the form and any additional documents that you think may assist our compliance team during the on-boarding process.

For example: Investment Management Agreement, Partnership Deed, Trust Deed, Marketing Material, Corporate Policies, etc. (you can upload multiple files).

10.4 I hereby confirm that I am duly authorised to complete and submit the Ibanera Corporate Account Opening Form on behalf of the entity described herein and certify that the information contained is a true and accurate record in relation to the entity described above. *