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					                                      Application for a WebMoney Transfer Verified Passport for corporate users


WM-ID: __ __ __ __ __ __ __ __ __ __ __ __

Company Information

Registered company name: ____________________________________________________________________________________________

Country/City of registration: ____________________________________________________________________________________________

Date formed (MM/DD/YYYY): ________________________________ Company registration number: _________________________________

Full name(s) of executive director(s): _____________________________________________________________________________________

Registered Address

Street: ______________________________________________________________ State//District: __________________________________

Zip/Postal Code: _____________________________ Country/City: ____________________________________________________________

Actual business (operation) address

Street: _____________________________________________________ State//District: __________________________________________

Zip/Postal Code: _____________________________________________ Country/City: ___________________________________________

Сontact information

Personal email address:_____________________________________________WWW: ___________________________________________

Position/title within the company: _______________________________________________________________________________________

Last Name: _______________________________ First Name: ____________________________ Middle Name: ______________________

ID Type: __________________________________ ID Number: _____________________________________________________________

Issued by: ________________________________________________________________________________________________________

Place of issue (Country/City): _______________________________________ Date of issue (MM/DD/YYYY): _________________________

Nationality: _____________________________________ Date of Birth (MM/DD/YYYY): __________________________________________

Place of Birth (Country/City): __________________________________________________________________________________________

I am requesting the operator of WebMoney Transfer System (WM Transfer Ltd.) to accept my personal data for certification and authorize me as a
legal holder of WebMoney Transfer _________________________________ Passport.
                                           Personal or Initial

I hereby confirm that all documents, compiled online using my WebMoney Transfer Identifier (WMID) as well as agreements and procedures,
accepted online are acknowledged by me as if I was compiling on paper and signing them with my own handwritten signature.

I hereby confirm that all documents, composed by me in electronic format/online using my WMID by means of WebMoney Transfer system, as well
as all other rules and procedures of the System, formed online are acknowledged and accepted by me as if they were created and signed by him in
person and on paper.

I hereby acknowledge that all actions, performed by me via WebMoney Transfer tools and recorded/registered online with my WMID serve as
expression of my own intentions and declaration of my will to establish, change or terminate my legal relationship when performing an activity. Such
actions can be as well used to confirm/verify the activities, performed online in front of a court or when solving disputes by means of arbitration in
order to confirm their validity and legal power.

                                                                                                  My signature: _____________________________

                                                                                                                      Date: ____/ ____/200___
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