FOGOT AS
reg. nr. 10225817

APPLICATION
of new user - private person
Personal data collection is caused by the requirements of the "Money Laundering and Terrorist Financing Prevention Act".
 The data will be retained for five years after the completion of business relations.
1.	Name:		Surname:		
(given as in accordance with identification document)
2.	Personal code/date of birth:		
(please give DOB in case you do not have a personal code)
3.	Residential address:		
(please give a residential address or address of registration)
4.	Telephone:		

5.	E-mail:		

6.	WMID:		

7.	Occupation:		
(for example: unemployed, student, an employee of commercial enterprise, office employee, etc.)
8.	I am a politically imposed person2, member of his family, close colleague		
(please put YES or NO)

Please perform for me a transaction with WebMoney in accordance with terms of CONTRACT OF RECORD (http://www.fogot.ee/exchange/en/dogovorw.html).

	/allkirjastatud digitaalselt/	
date	signature	

2 Politically imposed persons: 
1) Head of State, of Government, Minister, Deputy Minister and Assistant of Minister;
2) Member of Parliament; 
3) Judge of Supreme Court, of Constitutional Court or any other higher courts, whose judgments might be appealed further only in exceptional cases;
4) Board member of state control body and board member of Central Bank; 
5) Ambassador, charge d'affaires and higher military officer; 
6) Member of management, supervisory and administration bodies of state commercial union.