Application for a WebMoney Transfer Verified Passport for ...

[Pages:1]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): ______________________________________________ ontact 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.

Date: ____/ ____/202___

My signature: _____________________________

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