Client Application Form - Monavate | Complete Card Programme Management, BIN Sponsorship and Issuing Services from the Fintech Experts

1Product & Service

2General

3Projections

4Ownership Structure

5Declaration

Name

First Last

General

We look forward to working with you. But first, we just need a few details. This application form will take 20-30 minutes to complete. It can be saved at anytime, and returned to later using the button at the bottom of each page. If you have any questions on the information required we will be happy to help via phone or by email. Just contact a member of the support team here.

Applicant Details

Application contact Name

Application contact e-mail address

Application contact telephone number

Director Details

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Number of Directors

Director 1 Shareholder % (if applicable)

Director 1 Full name

Director 1 Date of birth

Director 1 Residential address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Director 1 Nationality

Director 1 Business telephone number

Director 1 Mobile number (if different)

Director 1 Email address

Director 2 Shareholder % (if applicable)

Director 2 Full name

Director 2 Date of birth

Director 2 Residential address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Director 2 Nationality

Director 2 Business telephone number

Director 2 Mobile number (if different)

Director 2 Email address

Director 3 Shareholder % (if applicable)

Director 3 Full name

Director 3 Date of birth

Director 3 Residential address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Director 3 Nationality

Director 3 Business telephone number

Director 3 Mobile number (if different)

Director 3 Email address

Director 4 Shareholder % (if applicable)

Director 4 Full name

Director 4 Date of birth

Director 4 Residential address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Director 4 Nationality

Director 4 Business telephone number

Director 4 Mobile number (if different)

Director 4 Email address

Program Overview

Summary of program. If available please include pitch deck or business case in upload at end

Anticipated Go Live Date

No fields to fill in here please go to next section

Issuing & Processing

Annual Projections

Gross Transaction Volume - GTV (£)

Yr1

Yr2

Yr3

Yr4

Yr5

No. Transactions

No. Transactions Yr1

No. Transactions Yr2

No. Transactions Yr3

No. Transactions Yr4

No. Transactions Yr5

No. Cards

Yr1

Yr2

Yr3

Yr4

Yr5

No. Cardholders

Yr1

Yr2

Yr3

Yr4

Yr5

Yr.1 Monthly Projections

GTV (£) by Month

Month 1

Month 2

Month 3

Month 4

Month 5

Month 6

Month 7

Month 8

Month 9

Month 10

Month 11

Month 12

No. Cards by Month

Month 1

Month 2

Month 3

Month 4

Month 5

Month 6

Month 7

Month 8

Month 9

Month 10

Month 11

Month 12

No. Cardholders by Month

Month 1

Month 2

Month 3

Month 4

Month 5

Month 6

Month 7

Month 8

Month 9

Month 10

Month 11

Month 12

Regionality (%)

Domestic

Please enter a number from 0 to 100.

Intra-Regional

Please enter a number from 0 to 100.

International

Please enter a number from 0 to 100.

Average Daily Gross Transaction Volume (£)

Average Daily Settlement Value (£) (BIN Sponsorship applicants only)

IBAN

Annual Projections

Value (£) In / Out

Yr1

Yr2

Yr3

Yr4

Yr5

No. Transactions

Yr1

Yr2

Yr3

Yr4

Yr5

No.Accounts

No.Accounts Yr1

No.Accounts Yr2

No.Accounts Yr3

No.Accounts Yr4

No.Accounts Yr5

Yr.1 Monthly Projections

Value (£) In / Out

Month 1

Month 2

Month 3

Month 4

Month 5

Month 6

Month 7

Month 8

Month 9

Month 10

Month 11

Month 12

No. Accounts

Month 1

Month 2

Month 3

Month 4

Month 5

Month 6

Month 7

Month 8

Month 9

Month 10

Month 11

Month 12

No. Transactions

Month 1

Month 2

Month 3

Month 4

Month 5

Month 6

Month 7

Month 8

Month 9

Month 10

Month 11

Month 12

ATM

Annual Projections

DCC

Yr1

Yr2

Yr3

Yr4

Yr5

Cash Withdrawal

Cash Withdrawal Yr1

Cash Withdrawal Yr2

Cash Withdrawal Yr3

Cash Withdrawal Yr4

Cash Withdrawal Yr5

Balance Enquiry

Beneficial Owners (25% and above)

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Number of Beneficial Owners

Beneficial owner 1 Full Name

Beneficial owner 1 Date of Birth

Beneficial owner 1 Residential Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Beneficial owner 1 Nationality

Beneficial owner 1 Business telephone number

Beneficial owner 1 Mobile number

Beneficial owner 1 Email Address

Beneficial owner 2 Full Name

Beneficial owner 2 Date of Birth

Beneficial owner 2 Residential Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Beneficial owner 2 Nationality

Beneficial owner 2 Business telephone number

Beneficial owner 2 Mobile number

Beneficial owner 2 Email Address

Beneficial owner 3 Full Name

Beneficial owner 3 Date of Birth

Beneficial owner 3 Residential Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Beneficial owner 3 Nationality

Beneficial owner 3 Business telephone number

Beneficial owner 3 Mobile number

Beneficial owner 3 Email Address

Beneficial owner 4 Full Name

Beneficial owner 4 Date of Birth

Beneficial owner 4 Residential Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Beneficial owner 4 Nationality

Beneficial owner 4 Business telephone number

Beneficial owner 4 Mobile number

Beneficial owner 4 Email Address

Company Structure

Please provide a written or visual company structure/org chart - containing names, incorporations locations and registration details. Please ensure you provide the supporting documents as requested

Co-Brand Partners

Please provide details of any brands you are working with, company name, the nature of program being operated and specify the relationship. If this is not applicable then please leave this section blank

Relevant files, Please upload here:

Drop files here or

Max. file size: 8 MB.

Declaration

Applicant Signature

Name

Title / company position

Signature

Yes

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Date

General

Applicant Details

Company Information

Director Details

Program Overview

Product & Service

Card Product (Please indicate % of traffic)

Program Goods or Services Category %

Source of funds

Distribution Profile

Scheme %

No fields to fill in here please go to next section

Issuing & Processing

Annual Projections

Yr.1 Monthly Projections

GTV (£) by Month

No. Cards by Month

No. Cardholders by Month

Regionality (%)

IBAN

Annual Projections

Yr.1 Monthly Projections

Value (£) In / Out

No. Accounts

No. Transactions

ATM

Annual Projections

Yr.1 Monthly Projections

DCC

Cash Withdrawal

Balance Enquiry

PIN Change

Ownership Structure

Beneficial Owners (25% and above)

Company Structure

Co-Brand Partners

Declaration

Applicant Signature