Gallery – Policlínica Body-Balance

E-mail address *

Type of company *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

IAE Code (Form 036/037) *

Do you need a licence or certification for your activity? *

Are you subject to the law on money laundering and terrorist financing? *

Attach census registration document *

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In which countries do you serve? *

Where will you use Bitnovo Pay? *

Physical shop
Online

How will you use the service? *

POS
Mobile App
Ecommerce integration
Integration via API

Estimated sales volume per month *

Average ticket volume *

Type of management body *

Administrators

Type of administrator *

Name *

First

Last

DNI/NIE *

E-mail address *

Nationality *

Country of residence *

Please attach both sides of your DNI/NIE document. *

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Please attach proof of representation *

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Company name *

NIF *

Name of legal representative *

First

Last

DNI/NIE of the legal representative *

E-mail of the legal representative *

Email

Confirm Email

Nationality of the legal representative *

Country of residence of the legal representative *

Please attach both sides of your DNI/NIE document. *

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Proof of representation *

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Do any persons directly or indirectly control more than 25% of the capital or voting rights of a legal person? *

Actual headlines

Name *

First

Last

DNI/NIE *

Nationality *

Country of residence *

E-mail address *

Percentage of share capital *

Please attach both sides of your DNI/NIE document. *

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Does the company have a code of ethics or conduct? *

Is there a compliance department and a compliance policy? *

Does the company maintain a whistleblower channel? *

Are there any known potential conflicts of interest? *

Currency *

IBAN *

Certificate of title *

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GDPR *

By ticking this box I authorise Capital Crypto Technology SLU to manage the registration of my establishment in Bitnovo Pay® and I agree to the processing of my personal data and those of my company in accordance with the provisions of the Privacy policy of this website.

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