Investment Partner Application

Monthly Dividend Disbursement (MDD) — Proprietary Trading Partnership

Confidential

Partner Information

Partner Type*

Full Legal Name*

Date of Birth

Nationality

Passport / ID Number

Passport Expiry Date

Email Address*

Phone Number

Residential / Registered Address*

City

Country

Postal Code

Partnership Capital Details

Capital Commitment*

Currency

Source of Funds*

Distribution Preference

Reinvest DistributionsBank TransferCrypto Wallet

Accredited Partner Status

VeroChain exclusively onboards qualified Investment Partners. Please indicate the basis on which you qualify.

Net worth exceeding $1,000,000 (excluding primary residence)Annual income exceeding $200,000 (or $300,000 jointly) in each of the last two yearsEntity with total assets exceeding $5,000,000Licensed financial professional (Series 7, 65, or 82)Institutional partner (bank, insurance company, registered investment company)Other qualified partner status (please contact partner relations for details)

Politically Exposed Person (PEP) Declaration

Are you, or any of your immediate family members, a current or former senior political figure, senior government official, or senior executive of a state-owned enterprise?

NoYes

Electronic Signature

Full Legal Name*

Date*

Signature *

Draw your signature here

I hereby certify that the information provided in this application is true, accurate, and complete to the best of my knowledge. I understand that VeroChain DMCC reserves the right to verify all information provided and to reject any application at its sole discretion. I authorize VeroChain to conduct all necessary due diligence checks as required by applicable laws and regulations.

Your application will be reviewed by our partner relations team within 2 business days. VeroChain is a proprietary trading firm and maintains a selective admission process.