Vendor / Seller KYC Form Template

Company (Requesting KYC): [Your Company Name]
Vendor/Seller Legal Name: [Vendor Legal Name]
Trading Name (DBA) (If Any): [DBA]
Vendor ID (Optional): [ID]
Date Submitted: [Date]

Primary Contact Name/Title: [Name, Title]
Email/Phone: [Contact]

1. Business Identity

1.1 Entity Type: ☐ LLC ☐ Corporation ☐ Partnership ☐ Sole proprietorship ☐ Other: []
1.2 Country/State of Registration: []
1.3 Registration/Company Number: []
1.4 Tax ID (Last 4 digits only) (Optional): [____]
1.5 Registered Address: []
1.6 Operating Address (If Different): []
1.7 Website/Storefront URL (Optional): []

2. Business Activity

2.1 Products/Services Sold: [Describe].
2.2 Industry Category: []
2.3 Countries Served/Shipped To: [List].
2.4 Expected Monthly Sales/Payouts (Optional): $[].
2.5 Refund/Chargeback History (Optional): ☐ None ☐ Yes (describe): [__].

3. Ownership and Control

3.1 Beneficial Owners (Individuals who own/control [__]%+ or as required):

• Name: [] | Ownership %: [] | Country of residence: [__]

• Name: [] | Ownership %: [] | Country of residence: [__]

3.2 Directors/Managers/Controllers:

• Name: [] | Title: [] | Country: [__]

• Name: [] | Title: [] | Country: [__]

3.3 Authorized Signer for This Form: [Name/Title].

4. Verification Documents (Attach as Requested)

4.1 ☐ Certificate of incorporation/registration
4.2 ☐ Registry extract / good standing certificate
4.3 ☐ Proof of business address
4.4 ☐ Ownership chart/cap table (if applicable)
4.5 ☐ Photo ID for owners/controllers (as required)
4.6 ☐ Tax form (W-9/W-8 or local equivalent) (optional)
4.7 ☐ Other: [List]

5. Sanctions/PEP and Risk Checks (Optional/Internal)

5.1 Screening performed by [Your Company]:

• Sanctions: ☐ Clear ☐ Possible match ☐ Not performed

• PEP: ☐ Clear ☐ Possible match ☐ Not performed

• Adverse media: ☐ Clear ☐ Concern ☐ Not performed
  5.2 Notes: [Internal notes].

6. Payment / Payout Information

6.1 Payment Method: ☐ Bank transfer ☐ ACH ☐ Wire ☐ PayPal ☐ Other: []
6.2 Account Holder Name: []
6.3 Bank Name: []
6.4 Bank Country: []
6.5 Routing/SWIFT (Optional): []
6.6 Account Number (Last 4 digits only): [____]
6.7 Payout Email/Account (If Applicable): []

7. Certification

7.1 The undersigned certifies they are authorized to provide this information and that it is true and complete to the best of their knowledge.
7.2 The vendor agrees to notify [Your Company] of material changes (ownership, address, banking details) within [__] days.

Signatures

Authorized Representative: [Full Name]
Title: [Title]
Date: [Date]
Signature: ___________________________