IMANI Customer Onbaording

IMANI Customer Registration Form

*Company NameEnter Name of Company Applying

*Company AddressPlease Enter your Company Address

*Certified Guichet unique- Certificate RCCMPlease Upload the Certified Guichet Unique- Certificate RCCM

*Notary Deed/Acte de NotairePlease upload the Notary deed/Acte de Notaire document from Guichet Unique

*Certified TVA or ID NATPlease Upload the Certified TVA or ID NAT

Certified Trading LicencePlease Upload the Certified Trading Licence

Aggregation Services Application LetterPlease Upload Aggregation Services Application Letter on Company letterhead

Certified IDs of All Share HoldersPlease Upload Certified IDs of All Share Holders

*Passport Size Photos of all Share HoldersPlease upload Passport Size Photos of all Share Holders

*Articles of Association STATUTSPlease Upload Articles of Association STATUTS

*Source and volume of funds the account is expected to be receiving and disbursingPlease Declare

*Valid Lotteries Board or BETTING Licence or Regulatory LicencePlease Upload Valid Lotteries Board or BETTING Licence or Regulatory Licence

*Latest audited or Prior Financial statementsPlease Upload any Financial Documents you Currently have

Business CasePlease upload the filled Business Case, Contact us on info@imanitechnologies.com in case you need assistance with filling this

*Signed Merchant AgreementPlease Upload Signed and Stamped Signed Merchant Agreement

*Signed Compliance PolicyPlease Upload Signed Compliance Policy

*Signed Non Disclosure AgreementPlease Upload Signed Non Disclosure Agreement

*Signed Anti Money Laundering PolicyPlease Submit Signed Anti Money Laundering Policy

Phone Number of Authorised SignatoryPlease enter Phone Number of Authorised Signatory

*Email of Authorised SignatoryPlease Enter Email of Authorised Signatory

*Confirmation

Yest it True     No its not True     Partially True    

I Confirm that all the information we have supplied in this application is Authentic

Fields with (*) are compulsory.