BITRAINCOIN KYC

1
This application form includes TXID entry fields for ID upload, sending cryptocurrency, proof of transaction.

Please be prepared for ICO participation and fill in the form.
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2
Nationality* This field is requiredPlease enter your nationality.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
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Guadeloupe
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Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
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Hong Kong
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Iceland
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Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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3
E-mail* This field is requiredPlease enter your email address. (Notice: Email entered may be used for identification later on. Don't forget your address)
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification.
••••
Didn't receive verification code? orReceiving the email may take a few minutes, thank you for your patience!
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4
Phone Number* This field is requiredPlease enter your mobile number. (Notice: Mobile number entered may be used for identification later on. Don't forget your number)
Area Code
Phone Number
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5
Name (English)* This field is requiredPlease enter your full name registered in your passport.
First Name
Last Name
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6
Identification Card* This field is requiredA color copy of a valid government issued photo ID (e.g. passport, driving license or ID card)
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Browse Files
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7
Please follow the instruction.Please upload a your picture holding a color copy of a valid government issued photo ID (e.g. passport, driving license or ID card).
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8
Your photo with ID* This field is requiredUpload photo of your upper body while holding your identification card just as illustrated.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Browse Files
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9
Personal Ethereum (ETH) Wallet Address* This field is requiredPlease enter your personal Ethereum wallet address to claim TAM.
Notice: Ethereum wallet address of an exchange is prohibited. Please enter personal Ethereum address such as MEW etc. The company does not take responsibility of tokens lost due to incorrect address registration etc.)
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10
Please enter ETH amount to participate ICO* This field is requiredExchange Rate : 1 BRC = 0.03 USD
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11
Please send correct ETH amount to the following Ethereum(ETH) address.

0x75AFe81Ce8b310C338A115278B9cDf56615b4853

Caution

1. Copy the address shown for sending.

2. Do not skip this step unless TXID is generated.

3. Please be advised that you can't receive the token with exchange wallet. Please use personal Ethereum wallet (eg. My Ether Wallet).

※ The company will not be responsible for wrong deposit due to person's ignorance of instruction.
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12
TXID * This field is requiredPlease enter Ethereum (ETH) sent TXID.
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13
Congratulation. You have successfully participated at BITRAINCOIN(BRC) ICO.

Inquiry : sales@bitrain.io
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