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Section 1 - Institution Name

Please enter the institution name.
Please select Yes or No.
Please select Yes or No.

Section 2 - Primary Address (No P.O. Boxes Allowed):

Please enter the Address Line 1.
Please select the Country.
Please select the State. Please select the Province.
Please enter the City.
Please enter the Zip code. Please enter the Postal code.

Section 3 - Registered Address

Please select Yes or No.

If no, please provide the registered address information below.

Please enter the Address Line 1.
Please select the Country.
Please select the State. Please select the Province.
Please enter the City.
Please enter the Zip Code. Please enter the Postal Code.
Please complete the reCAPTCHA.

Section 4 - Type of Entity

Please select an entity type.

Section 5 - Information about your Institution

Please enter the tax id number.
Please enter the Business Registration Number.
Please select the Country of Formation.
Please select the State of Formation. Please select the Province.
Date is required
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Please select Yes or No.
Please select Yes or No.
Please select the Country.
Please enter Customer types.
Please select Yes or No.
Please select Yes or No.
Please select Yes or No.
Please select the Country.
Please select the Country.
Please enter Customer types.
Please select Yes or No.
Please enter Primary counries served by your organization.
Please select Yes or No.
Please enter Who overseas the organization
Please enter Who are the organization’s Donors.
Please enter Legal name of all Charitable Organization(s), Government(s) or Association(s) that you are affiliated with.
Please Describe activity of Charitable Organizations, Government(s) or Association(s) listed.
Please enter Source of funds.
Please enter Name of Donors.
Please enter Where are your donors located.
Please enter What does the organization provide to its recipients.
Please enter What types of groups do you give to.
Please enter Where are your recipients located.
Please select Yes or No.
Please enter the types of volunteers.
Please enter Where are volunteers located.
Please select Yes or No.
Please enter Annual Total Revenue:.
Please enter Average Transaction Amount.
Please enter High Ticket Price.
Please enter Maximum Sale Limit
Please enter Annual Credit Sales Amount.
Please enter Annual Quantity of Debit Transactions.
Please enter Annual Quantity of Credit Transactions.
Please enter Projected Refunds.
Please enter Maximum Refund Limit Amount.
Please enter Annual Credit Card Refunds Count.
Please enter Annual Credit Card Refund Amount.
Please enter Projected Annual Chargebacks Count.
Please enter Projected Annual Chargebacks Amount.
Please select at least one card.
Please enter Average Sale Amount.
Please enter Number of High Sales Anually.
Please enter High Sale Amount.
Please enter Annual Revenue.
Please enter Total Monthly Credit Card Sales.
Please enter Cardholder Descriptor.
Please enter customer types.
Please enter AMEX Transaction Count.
Please enter AMEX Sales Amount.
Please enter AMEX Refund Count.
Please enter AMEX Refund Amount.
Please enter Total Annual Revenue.
Date is required
Please enter your sources of Capital.
Please enter the Amount of Assets.
Please select Estimated or Actual.
Please enter Cardholder Descriptor.
Please enter Average Transaction Amount.
Please enter Annual Quantity of Transactions.
Please enter High Ticket Price.
Please enter Total Annual Revenue.
Please enter Monthly Minimum Amount for debit and credit transaction.
Please enter Debit Single Transaction Amount.
Please enter Debit Single Day Count.
Please enter Debit Single Day Amount.
Please enter Debit Period Count.
Please enter Debit Period Amount.
Please enter Debit Refund Single Transaction Amount.
Please enter Debit Refund Single Day Count.
Please enter Debit Refund Period Count.
Please enter Debit Refund Period Amount.
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Section 6 - How you plan to use our International Payments Services

Your planned usage is to receive student tuition and fee payments from third party senders on behalf of students attending your Institution. Please provide the average number and size of your estimated international payments per month below.

Section 7 - Parent Company Information

The information requested in this section should be provided if another legal entity (such as a corporation or partnership) holds a 25% or greater interest in the Institution named in Section 1.

Please ensure the box is checked to continue, otherwise provide the parent company information below.

For each legal entity that owns at least a 25% interest, please provide the following information:

Please enter the Legal Name.
Please enter the DBA / Trade name(s).
Please enter the Address Line 1.
Please select the country.
Please select the State. Please select the Province.
Please enter the City.
Please enter the Zip Code. Please enter the Postal Code.
Please enter the Telephone Number. Please enter a valid Telephone Number.
Add Additional Beneficiary
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Section 8 - Authorized Signatory

Please select Yes or No.

If no, please provide the authorized signatory’s information below.

Please enter the First Name.
Please enter the Last Name.
Please enter the email. Please enter a valid email address.
Please enter the Telephone Number. Please enter a valid Telephone Number.

Please enter the Full Name.
Please enter the email. Please enter a valid email address.
Please enter the Telephone Number. Please enter a valid Telephone Number.

Please enter the Full Name.
Please enter Title.
Please enter the email. Please enter a valid email address.
Please enter Residential Address.
Please enter City.
Please enter State. Please enter Province.
Please enter Zip Code.
Please enter social security number.
Date is required
Please select Document Type.
Please enter the Government Issued Id No.

Please enter the Full Name.
Please enter Title.
Please enter the email. Please enter a valid email address.
Please enter Residential Address.
Please enter City.
Please enter State. Please enter Province.
Please enter Zip Code.
Please enter social security number.
Date is required
Please enter this officer's role.
Please select Yes or No.
Please select Yes or No.
Please select Government Issued ID Type.
Please enter Government Issued Id No.
Please select Who oversees the organization.
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Section 9 - Signature

By signing below, the Institution hereby acknowledges it has received, read, and agrees to transact business with MTFX USA Inc. (“MTFX”) and agrees to abide by all applicable governmental laws and regulations in the conduct of its business dealings with MTFX consistent with its “Know Your Customer” obligations under the Bank Secrecy Act and the USA PATRIOT Act. The Institution certifies that all the information provided in this Know Your Client Questionnaire is true and correct. The Institution agrees to notify MTFX in the event that there is a material change in any of the information submitted. A facsimile or scanned copy of this signature shall have the same force and effect as an original and shall be binding.

By signing below, the Institution hereby acknowledges it has received, read, and agrees to transact business with MTFX Inc. (“MTFX”) and agrees to abide by all applicable governmental laws and regulations in the conduct of its business dealings with MTFX consistent with its “Know Your Customer” obligations under the proceeds of Crime (Money Laundering) and Terrorist Financing Act (the Act). The Institution certifies that all the information provided in this Know Your Client Questionnaire is true and correct. The Institution agrees to notify MTFX in the event that there is a material change in any of the information submitted. A facsimile or scanned copy of this signature shall have the same force and effect as an original and shall be binding.

Please enter the Insititution Name.
Please enter the name of the authorized signatory.
Please enter the Title / Role of Authorized Signatory.
Please enter the email. Please enter a valid email address.
Please enter the Residential Address.
Please enter the City.
Please enter the Country.
Please enter the State. Please enter the Province.
Please enter the Zip Code.
Please enter the Mobile/Direct Number.
Please select Government Issued ID Type.
Please enter the Government Issued ID No.
Date is required
Date is required

Thank you!

Your questionnaire has been successfully completed.

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