CrossTower Institutional Application Form

Thank you for your interest in becoming a CrossTower Customer! If you have any questions, please contact [email protected].
Please DO NOT send any sensitive information via email.

Applicant Information

Are any of the Control Person is Politically Exposed Person (PEP)? –

The term "Politically Exposed Person" generally includes a current or former senior foreign political figure, their immediate family, and their close associates.


List control persons with executive authority (e.g., C-level role, Partners, President, Managing Members, Officers) that will be involved in activity on the CrossTower Exchange.

Full Name Title / Role Company Email Date of Birth
1 Person
2 Person
3 Person

Please provide the following information about your bank account.

Anti-Money Laundering / Anti-Terrorist Financing Program Document: *

Please upload a copy of your AML/ATF Program Document (including KYC/Customer Identification Program and AML Risk Assessment) to the secure upload portal along with this application. If you are not required to maintain an AML/ATF Program, please explain why you are not required to have one.

By signing this Application, you represent and warrant:

  1. 1. You have received the CrossTower Global’ s Terms of Use from us and read, or have had sufficient opportunity to have read, and agree to the terms and conditions of the Terms of Use.
  2. 2. You and your Authorized Users are accurately described in this Application.
  3. 3. You have full power and authority to execute, deliver, and perform the obligations under this Application and the Terms of Use.
  4. 4. You have consulted or declined to consult with counsel and/or experts of your own selection prior to executing this Application.
  5. 5. agree to indemnify, defend, and hold harmless CrossTower Global from any and all claims, actions, causes of action, complaints, demands, liabilities, and obligations (including legal and all other expenses) made against or suffered by CrossTower Global as a result of relying upon this Application; and
  6. 6. this Application and the Terms of Use have been duly authorized, executed, and delivered by you and are legal, valid, and binding obligations of you, enforceable in accordance with their terms.





31 CFR § 1010.230 CERTIFICATION REGARDING
BENEFICIAL OWNERSOF LEGALENTITYCUSTOMERS




I. GENERALINSTRUCTIONS

This is an optional form provided for your convenience. The required information may be provided in other formats. When completed, this form is provided to the financial institution where the account is opened. DO NOT SEND TO FinCEN.

Where may I obtain a copy of the form?

A copy (pdf) may be downloaded from the FinCEN website at www.fincen.gov under the "Filing Information" tab. The form may be completed on a computer using the free Adobe Reader software.

What is this form?

To help the government fight financial crime, Federal regulation requires certain financial institutions to obtain, verify, and
record information about the beneficial owners of legal entity customers. Legal entities can be abused to disguise
involvement in terrorist financing, money laundering, tax evasion, corruption, fraud, and other financial crimes. Requiring
the disclosure of key individuals who own or control a legal entity (i.e., the beneficial owners) helps law enforcement
investigate and prosecute these crimes.

Who has to complete this form?

This form must be completed by any person opening a new account on behalf of a legal entity with any of the following U.S. financial institutions: (i) a bank or credit union; (ii) a broker or dealer in securities; (iii) a mutual fund; (iv) a futures commission merchant; and (v) an introducing broker in commodities.

For the purposes of this form, a legal entity includes a corporation, limited liability company, or other entity that is created by
a filing of a public document with a Secretary of State or similar office, a general partnership, and any similar business entity
formed in the United States or a foreign country. legal entity does not include sole proprietorships, unincorporated associations,
or natural persons opening accounts on their own behalf.

What information do I have to provide?

When you open a new account on behalf of a legal entity, the financial institution will ask for information about the legal entity's beneficial owner(s), including their name, address, date of birth and social security number (or passport number or other similar information, in the case of Non-U.S. persons). The financial institution may also ask to see a copy of a driver's license or other identifying document for each beneficial owner listed on this form.

Beneficial owners are:
         (1) Each individual, if any, who owns, directly or indirectly, 25 percent or more of the equity interests of
           the legal entity customer (e.g., each natural person that owns 25 percent or more of the shares of a
           corporation; and
         (2)An individual with significant responsibility for managing the legal entity customer (e.g., a Chief
           Executive Officer, Chief Financial Officer, Chief Operating Officer, Managing Member, General Partner,
           President, Vice President, or Treasurer).

The number of individuals that satisfy this definition of "beneficial owner" may vary. Under section (1), depending on the
factual circumstances, up to four individuals (but as few as zero) may need to be identified. Regardless of the number of
individuals identified under section (1), you must provide the identifying information of one individual under section (2). It is
possible that in some circumstances the same individual might be identified under both sections (e.g., the President of Acme,
Inc. who also holds a 30% equity interest). Thus, a completed form will contain the identifying information of at least one
individual (under section (2)), and up to five individuals (i.e., one individual under section (2) and four 25 percent equity
holders under section (1))

a legal entity may have multiple "beneficial owners," this form requires you to list only those that own 25% or more (up
to five) under each of the two prongs of the definition above. If appropriate, the same individuals may be listed under
both prongs.

CERTIFICATION OF BENEFICIAL OWNER(S)

The information contained in this Certification is sought pursuant to Section 1020.230
of Title 31 of the United States Code of Federal Regulations (31 CFR 1020.230).

All persons opening an account on behalf of a legal entity must provide the following information:

SECTION I

Please provide the following information for an individual(s), if any, who, directly or indirectly, through any contract arrangement, understanding, relationship, or otherwise owns 25% or more of the equity interests of the legal entity listed above. if no individual meets this definition and complete Section II.

Note: In lieu of a passport number, Non-U.S. Persons may also provide a Social Security Number, an alien identification card number, or number and country of issuance of any other government-issued document evidencing nationality or residence and bearing a photograph or similar safeguard.

SECTION II

Please provide the following information for an individual with significant responsibility for managing or directing the entity, including, an executive officer or senior manager (e.g., Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, Managing Member, General Partner, President, Vice President, Treasurer); or Any other individual who regularly performs similar functions.

Note: In lieu of a passport number, Non-U.S. Persons may also provide a Social Security Number, an alien identification card number, or number and country of issuance of any other government-issued document evidencing nationality or residence and bearing a photograph or similar safeguard.

I, (name of person opening account), hereby certify, to the best of my knowledge, that the information provided above is complete and correct.

Additional Section 1 - Second Beneficial Owner(If required)

Please provide the following information for an individual(s), if any, who, directly or indirectly, through any contract arrangement, understanding, relationship, or otherwise owns 25% or more of the equity interests of the legal entity listed above

Note: In lieu of a passport number, Non-U.S. Persons may also provide a Social Security Number, an alien identification card number, or number and country of issuance of any other government-issued document evidencing nationality or residence and bearing a photograph or similar safeguard.

Additional Section 1 - Third Beneficial Owner (If required)

Please provide the following information for an individual(s), if any, who, directly or indirectly, through any contract arrangement, understanding, relationship, or otherwise owns 25% or more of the equity interests of the legal entity listed above

Additional Section 1 - Fourth Beneficial Owner(If required)

Please provide the following information for an individual(s), if any, who, directly or indirectly, through any contract arrangement, understanding, relationship, or otherwise owns 25% or more of the equity interests of the legal entity listed above

Note: In lieu of a passport number, Non-U.S. Persons may also provide a Social Security Number, an alien identification card number, or number and country of issuance of any other government-issued document evidencing nationality or residence and bearing a photograph or similar safeguard.


Paperwork Reduction Act Notice

Public recordkeeping burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The OMB control number for this information collection is 1506-0070. You may submit comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, by calling the FinCEN Resource Center at 800-767-2825 or by email at [email protected] Alternatively, you may mail us comments at Policy Division, Financial Crimes Enforcement Network, P.O. Box 39, Vienna, VA 22183. Please include 1506-0070 in the body of the text.







CrossTower


Institutional Application Document Checklist

Thank you for your interest in becoming a customer of CrossTower! Below is a checklist for all required documents for your application as an institutional customer on the CrossTower trading platform. All documentation must be submitted in English. By submitting your institutional application, you hereby represent and warrant that all documents provided hereunder are true, complete, and accurate copies of the originals, and that there are no material omissions related thereto. If you have any questions, please contact [email protected]. Please do not send documentation through email; we will provide instructions on how you can safely upload your documentation to us.