Aurora Account Application Form

Welcome to Aurora Digital Trust - Complete the form below to start your banking journey

Application Reference: __________________ Date: __________________

For Office Use Only: Reviewed by: __________________ Status: __________________

Submitting your application...

Important: All fields marked with * are required. Your information is protected and will be used solely for account verification purposes. Please ensure all information is accurate and complete.

Instructions: Please complete all sections of this form in BLOCK CAPITALS. Ensure all required fields are filled accurately. Sign and date at the bottom of the form before submission.

Personal Information

First Name * First name is required

Last Name * Last name is required

Date of Birth * Must be 18 years or older Valid date of birth is required (18+ years)

Gender * Gender selection is required

Nationality * Nationality is required

Place of Birth (City, Country) * Place of birth is required

Marital Status * Marital status is required

Mother's Maiden Name * Required for identity verification and account recovery Mother's maiden name is required

Identification Documents

Primary Identification

Primary ID Type * ID type is required

Primary ID Number * ID number is required

ID Issue Date * ID issue date is required

ID Expiry Date * ID expiry date is required

ID Issuing Country * ID issuing country is required

Secondary Identification

Secondary ID Type * Secondary ID type is required

Secondary ID Number * Secondary ID number is required

Tax Information

Tax Identification Number (TIN) * Required for tax reporting and compliance (FATCA/CRS) Tax Identification Number is required

Primary Tax Residency Country * Country where you are primarily liable to pay taxes (CRS requirement) Tax residency country is required

Contact Information

Email Address * This will be your username for online banking Valid email address is required

Phone Number * Phone number is required

Residential Address

Street Address * Street address is required

City * City is required

State / Province / Region * State/Province/Region is required

Postal / ZIP Code * Postal/ZIP code is required

Country * Country is required

Employment & Financial Information

Employment Status * Employment status is required

Occupation * Occupation is required

Annual Income (Local Currency) * Annual income is required

Primary Source of Funds * Source of funds is required

Account Preferences

Account Type * Account type is required

Preferred Currency * Currency selection is required

Initial Deposit Amount * Minimum opening deposit varies by account type Initial deposit amount is required

Purpose of Account * Please describe the intended use of this account Purpose of account is required

Expected Account Activity

Expected Monthly Deposits * Expected monthly deposits is required

Expected Monthly Withdrawals * Expected monthly withdrawals is required

Expected Monthly Transactions * Expected number of transactions is required

Expected Average Account Balance * Expected account balance is required

Emergency Contact & Beneficiary Information

Emergency Contact

Emergency Contact Name * Emergency contact name is required

Relationship * Relationship is required

Emergency Contact Phone * Emergency contact phone is required

Primary Beneficiary

Beneficiary Full Name * Person to inherit account in case of death Beneficiary name is required

Relationship to You * Beneficiary relationship is required

Beneficiary Date of Birth * Beneficiary date of birth is required

Percentage Allocation * Must total 100% across all beneficiaries Beneficiary percentage is required

Account Features & Preferences

Statement Delivery Preference * Statement delivery preference is required

Statement Frequency * Statement frequency is required

Compliance & Declarations

I am a U.S. person for tax purposes (required for FATCA compliance)

I am a Politically Exposed Person (PEP) or related to one

I accept the Terms and Conditions and Privacy Policy *

You must accept the Terms and Conditions

I certify that all information provided is accurate and complete *

Declaration and Signature

Declaration: I hereby declare that all information provided in this application is true, accurate, and complete to the best of my knowledge. I understand that providing false or misleading information may result in the rejection of this application or closure of my account. I authorize Aurora Digital Trust to verify the information provided and to conduct necessary background checks as required by law.

Applicant Signature

Signature

Date

DD/MM/YYYY

Print Name

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Aurora Digital Trust
Address: [Bank Address] • Phone: [Bank Phone] • Email: info@auroradigitaltrust.net
www.auroradigitaltrust.net