Application for a WebMoney Transfer Verified Passport for private persons

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

Applicant Personal Information

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): _________________________________________________________________________

Permanent residential address

Street: ____________________________________________ Zip/Postal Code: ________________________________

State/District: _________________________ (Country/City): ______________________________________________

Сontact information

Contact phone number(s): __________________________________________________________________________

Personal email address: _____________________________________WWW: _______________________________

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: ____/ ____/202___