Money Transmitters Machaen Enterprises, Inc.

Money Transmitters

Issuer of Money Transmitter bonds in the USA

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Money Transmitters Application
Money Transmitters Questionnaire
Check List

Machaen Enterprises, Inc.

LICENSE/ PERMIT/ MISCELLANEOUS

BOND INFORMATION

TYPE OF BOND

AMOUNT OF BOND:

EFFECTIVE DATE

OBLIGEE NAME:

OBLIGEE ADDRESS:

EXPIRATION DATE: (IF OTHER THAN ONE YEAR)

BUSINESS INFORMATION

COMPANY NAME

PHONE #

FAX #

COMPANY ADDRESS

CITY

STATE

ZIP CODE:

COMPANY

NATURE OF BUSINESS

TYPE

OF OWNERS, PARTNERS OR MEMBERS

HOG LONG IN BUSINESS?

PREVIOUS BONDING COMPANY

REASON FOR CHANGING BONDING COMPANY:

EMAIL ADDRESS:

PERSONAL INFORMATION

APPLICANTS NAME:

SOCIAL SECURITY #

DATE OF BIRTH #

SPOUSE'S NAME:

SOCIAL SECURITY #:

DATE OF BIRTH:

RESIDENCE ADDRESS:

CITY:

STATE:

ZIP CODE:

ESTIMATED PERSONAL NET WORTH:

ARE YOU THE TRUSTEE, TRUSTOR OR BENEFICIARY OF ANY TRUST

EVER DECLARED BANKRUPTCY?

PENDING OR PRIOR IRS LIENS?

ANY LAWSUITS PENDING AGAINST YOU?

EVER DECLINED FOR BONDING PREVIOUSLY?

PERSONAL INFORMATION

CO-APPLICANTS NAME:

SOCIAL SECURITY #

DATE OF BIRTH #

SPOUSE'S NAME:

SOCIAL SECURITY #:

DATE OF BIRTH:

RESIDENCE ADDRESS:

CITY:

STATE:

ZIP CODE:

ESTIMATED PERSONAL NET WORTH:

ARE YOU THE TRUSTEE, TRUSTOR OR BENEFICIARY OF ANY TRUST

EVER DECLARED BANKRUPTCY?

PENDING OR PRIOR IRS LIENS?

ANY LAWSUITS PENDING AGAINST YOU?

EVER DECLINED FOR BONDING PREVIOUSLY?

I agree that any electronic signatures (including facsimile signatures) utilized in connection with the execution of this document shall be considered originals and be fully binding and enforceable. Further, the use of any electronic signature by a party shall be evidence of that party's intent to be bound to the terms of such document. The parties agree that they shall not raise any defense (statutory or otherwise) to the enforceability of this document based upon the fact an electronic signature has been used.

You must be registered to apply

Machaen Enterprises, Inc.

Money Transmitter Questionnaire

Business Name: (as it appears on state license)

Business Address:

Date Formed

Years under current ownership:

Please attach ownership breakdown

**Please attach ownership breakdown**

States licensed in:

**Please attach list of countries transmissions are sent to***

Business activities of applicant

Other:

If you’ve had previous bonding with another company, was there ever a claim on a bond?

Has your compliance manual been reviewed and accepted by the states you do business in?

**Please attach brief summary of Chief Compliance Officer’s background/experience in the industry (include their name)

What money transmitter associations do you belong to if any

Do you conduct money transmissions through:

Do you have employee dishonesty (fidelity) coverage?

Do you have cybercrime coverage?

Have you appointed as agents, or, are you partnering with, any virtual currency exchanger or operator?

Has the applicant/licensee, any principal officer, director, partner or an individual with a 10% or more ownership interest in applicant/licensee ever filed for bankruptcy or been involved with a business that filed bankruptcy?

Has any license been suspended/revoked or renewal refused by any state in which you conduct business

Have you been subject to enforcement action by a licensing authority in a state in which you have conducted business?

Has there been any changes in management in the last 12 months?

You must be registered to apply

Machaen Enterprises, Inc.

Surety & Fidelity Bond Agency

DOCUMENT CHECK LIST FOR MONEY TRANSMITTERS

THE FOLLOWING ARE THE DOCUMENTS REQUIRED FOR THE PROCESSING OF YOUR SURETY BOND APPLICATION: