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Inaccordancewiththerequirementsofcurrentantimoneylaundering,proceedsofcrimeand

counterterroristfinancinglegislation,wearerequiredtoestablishandrecordevidenceofthe
identityandsourceoffundsforallofourClientsbeforeestablishingabusinessrelationship.
BestAMLCTFpracticesrequirethatweimplementongoingmonitoringofallcustomer
transactionsandidentities.Youmaybesubjecttofollowupquestionsandenhancedcustomer
duediligenceproceduresatanytime.Failuretosatisfactorilyaddressanyoutstandingissuesor
questionscanresultin,amongotherthings,terminationofaccesstoyouraccountand
terminationoftheservicestoyou.

Declaration

Iconfirmhavingattachedselfattestedcopiesofcertaindocumentsdemonstratingproofof
identityandproofofaddress.Thedocumentsprovidedarevalidand,inthecaseofidentity
documents,haveavalidityofatleastsixmonths.Theproofofaddressisnotolderthanthree
months.

Idoherebysolemnlydeclarethattheinformationprovidedisuptodateandcorrect.The
documentsprovidedasproofofidentityandproofofaddresshavebeenselfattested.I
authorizeanymemberoftheBitfinexGroupofCompaniestoverifytheinformationprovidedto
confirmitsaccuracy.

Nameofapplicant:
Blockletters,allcaps

Bitfinexusername:

Emailaddress:

ApplicantSignature: Date:

Pleaseprint,sign,andattachthisdocumenttoyourBitfinexaccountusingtheformon
https://www.bitfinex.com/verification/kycorbyemailingtoc ompliance@bitfinex.com.

Pleasenoticethatnotsigningand/orcompletingthisforminalltheonlinesectionswillresultin
delaysintheverificationprocess.

Notice:CollectionandretentionofdataisinaccordancewiththeBitfinextermsofservice.

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