Capella Pay Application: Company Profile
Capella Pay Application: Company Profile
Capella Pay Application: Company Profile
Capella Pay Limited (“Capella Pay”) Products & Services Application Form (the “Application”) should be signed by or on behalf
of the Client. It is very important that the Client has read the Application and the declarations set out within in conjunction with the
Agreement (as defined in the “Declarations” section below) before signing. By signing the Application, you are confirming that the details
provided within are correct and that you have read, understood and agreed to be bound by the terms of the Agreement and that the
signatory has the capacity to enter into the agreement on behalf of the applicant (company). Please email completed
Application along with the necessary documents to compliance@capellapay.com
PLEASE COMPLETE IN BLOCK CAPITALS AND ANSWER ALL QUESTIONS
Company Profile
Website URL(s):
Number of Employees:
Number of Directors/Partners:
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CAPELLA PAY APPLICATION
Authorised Representative
Please provide details of each person authorised to instruct or order transactions on behalf of your company for matters related to
this Application and who will be the main contact for this business relationship and attach:
(1) a copy of a valid photo ID (passport or driver’s license), and
(2) a utility bill or bank statement (not more than 3 months old), confirming residential address.
Note: If the authorised representative is not a Director, then please attach an authority for them to act on the company’s behalf
signed by a Director.
County / State /
E-mail Address:
Province:
Please give details of any additional contacts who will have authority on the system to access reports and/or to post payments
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First Name:
Other Names:
Last Name:
Date of Birth:
E-mail Address:
Phone Number:
Position in Company:
** Use this space at bottom of page 2 and mention ALL additional countries that you will be receiving from or sending funds to,
Please Include the Percentage split.
** (Incoming Payments)
Currencies and Countries
** (Outgoing Payments)
Currencies and Countries
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CAPELLA PAY APPLICATION
Incoming Funds *
Outgoing Payments *
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CAPELLA PAY APPLICATION
Regulated Entity
Service Requirements
Please indicate which of Capella's Services you would like to use. Capella Pay will provide firm quotations of rates, set-up
requirements, file format instructions, and relevant service agreements in due course. Some of these services will be provided
through Capella's business and payment partners. Do not hesitate to contact us with questions about any of our services.
Further information can be found at: www.capellapay.com
Services
UK Faster Payments (GBP) SEPA (Euro) SWIFT ✔
Card Services Debit Card Credit Card
Client Safeguarding Account Card Acquiring Services for Merchants / Clients
Corporate IBAN Cross-Border Payment Solutions
Personal IBAN FX Services (including FX and forward Remittance Globally)
Bulk IBAN Services Trading in Digital Assets
Please give details of the company bank account for the transfer of funds to or from Capella Pay (* fill in applicable)
Bank Name
Bank Address:
Sort Code / Transit / ABA
No:
Account Name:
* Account Number:
* IBAN:
Currency of Account:
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CAPELLA PAY APPLICATION
Company Directors
Depending on your business type we require information from the following Principals to complete this section:
First Name
Other Names:
Last Name:
Date of Birth
E-mail Address:
Phone Number:
City:
Post Code:
County/Province/State:
Country:
Nationality:
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CAPELLA PAY APPLICATION
Please confirm the Shareholders and Ultimate Beneficial Owners. For trusts all parties with beneficial voting rights will need to be
identified.
Shareholders will be classified as beneficial if they hold 10% or more of the total share or voting rights. If the beneficial owner of a
company is another company or legal entity we will require an explanation to identify a natural person/s as beneficial owner.
First Name
Other Names
Last Name:
Date of Birth
E-mail Address:
Phone Number:
City:
Post Code:
County/Province/State:
Country:
Nationality:
% Ownership:
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CAPELLA PAY APPLICATION
Is the applicant company a member of a group of companies either as a subsidiary or a parent company?
If yes, please provide details on the other companies in the group and their relationship to the applicant company and
Please also provide an Organisational Chart.
Name of Group company Relationship to Country/Jurisdiction Are there common Are any of the
(please include any trading applicant company company is registered in. directors with applicant group companies
name) (Parent, Subsidiary, company (if yes please regulated (if yes
Related group member) name) please provide
details for
Example the FCA)
Do any of the above-named Directors, Shareholders, UBO’s or any members of their family hold a politically exposed
position or are they close associates or cohabitants of anyone who holds a politically exposed position ?
A politically exposed position is a head of state or government minister, senior politicians. A member of the executive
council or legislature, senior bureaucrat or government official. Ambassador, embassy attaché or counsellor. A high-
ranking officer in the armed forces. A member of the administrative management or supervisory body of a state-owned
enterprise. A member of a court of auditors or the board of a central bank. A head of a government agency. A member of a
supreme court, constitutional court or high level judicial body.
If yes, please name the person(s), position held by the PEP and the relationship:
Yes
No
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CAPELLA PAY APPLICATION
Please provide the following Required Documents which must be accompanied with this Application (Form A) and the EDD
Questionnaire (Form B).
Corporate Documents:
1. Certificate of Incorporation
2. Memorandum and Articles of Association
3. Copy of Register of Directors
4. Copy of Register of Shareholders
5. Certificate of Good Standing / Certificate of Incumbency (where applicable)
6. Copy of Company bank statement (last 3 months)
Individual(s) Documents:
NOTE: Where the Authorised Representative is not a Director of the company, a Director will need to confirm in writing the
name and authority of the of the person responsible for the administration of the account and we will need;
NOTE: In instances where the Entity is required to be Licensed and/or Regulated, we need;
NOTE: For Corporate shareholders (where the registered shareholder is another company), we need;
NOTE: In certain cases, other information or documents may be requested if required during the onboarding process, e.g.
Certification of Documents
A copy of the Business Plan, A Legal Opinion of the business model
Meeting in person, Video call, A Selfie with your passport
CV / Resume, Professional References
Source of Funds declaration
An Additional Proof of Identity and Proof of Address
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CAPELLA PAY APPLICATION
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CAPELLA PAY APPLICATION
Important Notice
Thepersonal information thatwecollectin thisapplication form and during thelifetimeof your accountiskeptprivate. We collect personal information
to determine your eligibility for products and services, to ensure high service standards, to meet regulatory requirements, and to verify your identity.
Personal information you provide to Capella Pay Limited willnotbeusedin anycommercialwayandwillnotbeprovidedtoanyoneelseexceptin
responsetoarequest fromregulatory, governmental or law enforcement agencies, orwith our businesspartners and service providers to assistus
in providing services to you. These business partners and service providers may be located within or outside of the European Economic Area.
Whenever we request services from our business partners, we enter into a contractual agreement to ensure confidentiality and share the leastamount
ofinformation needed toperform therequired task. A copy of Capella Payprivacypolicyisavailableupon request.
Capella Pay Limited (Capella Pay) designs and operates the Capella Pay websites and app. The Capella Pay business current account is an e-
money account provided by Syncom (UK) Limited (Syncom) which is an electronic money institution authorised and regulated by the Financial
Conduct Authority under the Electronic Money Regulations 2011 (FRN 932543) for the issuance of electronic money. Syncom holds an amount
equivalent to the money in Capella Pay current accounts in a safeguarding account with Clear Bank Ltd who are authorise by the Prudential
Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority (Financial Services Register
number: 754568). This in accordance with the Electronic Money Regulations 2011 gives customers protection against Syncom’s insolvency.
Capella Pay may request additional documentation after review of this Application Form.
Capella Pay may request relevant URLs or other relevant promotional material along with completed and signed service agreements beforewe can set
up accounts or process payments on your behalf. If service agreements have not been sent to you already, theywill be issued based on information
provided in this Application Form.
Declarations
Words and expressions used in this Application will, unless otherwise defined in this Application, have the same meaning
as set out in the Terms and Conditions. By signing this Application, you are:
• Confirming that you are duly authorised to sign for and act on behalf of the Company and no consent or approval is
required from any other person.
• Confirming that the information that you have provided in this Application is accurate and correctly reflects the
profile, products and services of your business and the payment services you wish to receive. You further confirm
and agree that you will notify Capella Pay in good time of any changes to the information provided herein.
• Agreeing to and authorising the searches, due diligence enquiries and use of your information as set out in
the Privacy Policy and Framework Terms for Payment Services.
• Acknowledging and agreeing that you have read and are bound by the terms of the Agreement (comprising this
Application, the Framework Terms, and such other documents as the two parties may from time to time agree which
together shall constitute the entire Agreement between the parties).
Signature
Signature:
Print name:
Position:
Date:
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