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Phone
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7
20
27
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351
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359
370
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380
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385
386
387
420
421
503
506
507
509
591
593
598
599
677
679
880
886
961
962
963
965
966
971
972
994
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Address
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City
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Valid until
Annual turnover
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up to 10 € 000.00
10 € 000.00 up to 25 000 €
25 € 000.00 50 000 €
50 € 000.00 up to 100 000 €
100 € 000.00 up to 200 000 €
200 € 000.00 up to 500 000 €
more than 500 000 €
I am the legal representative of the company
Is the company listed on a stock exchange?
If so, in which stock market?
Fields marked with * are mandatory.
Individual
Data and contacts
Full name
*
Email
*
Confirm email
*
Mobile
1
1
7
7
20
27
30
31
31
32
33
34
36
39
40
41
43
45
46
47
48
49
51
52
54
55
56
57
58
60
61
62
63
64
65
66
81
82
86
90
91
92
93
98
212
213
216
218
224
225
233
234
237
238
239
240
243
243
244
245
249
254
258
351
352
353
354
357
358
359
370
371
372
373
380
381
385
386
387
420
421
503
506
507
509
591
593
598
599
677
679
880
886
961
962
963
965
966
971
972
994
Phone
1
1
7
7
20
27
30
31
31
32
33
34
36
39
40
41
43
45
46
47
48
49
51
52
54
55
56
57
58
60
61
62
63
64
65
66
81
82
86
90
91
92
93
98
212
213
216
218
224
225
233
234
237
238
239
240
243
243
244
245
249
254
258
351
352
353
354
357
358
359
370
371
372
373
380
381
385
386
387
420
421
503
506
507
509
591
593
598
599
677
679
880
886
961
962
963
965
966
971
972
994
Country
*
Select a country
Afghanistan
South Africa
Germany
Andorra
Angola
Netherlands Antilles
Saudi Arabia
Algeria
Argentina
Australia
Austria
Azerbaijan
Bangladesh
Belgium
Bolivia
Bosnia and Herzegovina
Brazil
Bulgaria
Cape Verde
Cameroon
Canada
Kazakhstan
Chile
China
Cyprus
Colombia
South Korea
Costa do Marfim
Costa Rica
Croatia
Denmark
Egypt
El Salvador
United Arab Emirates
Ecuador
Slovakia
Slovenia
Spain
United States
Estonia
Fiji
Philippines
Finland
France
Ghana
Greece
Guinea
Equatorial Guinea
Guinea-Bissau
Haiti
Netherlands
Hong Kong (China)
Hungary
Solomon Islands
India
Indonesia
Iran
Ireland
Iceland
Israel
Italy
Jamaica
Japan
Jordan
Kosovo
Kuwait
Latvia
Lebanon
Libya
Lithuania
Luxembourg
Malaysia
Morocco
Mexico
Mozambique
Moldavia
Nigeria
Norway
New Zealand
Netherlands
Panama
Pakistan
Peru
Poland
Portugal
Kenya
United Kingdom
Czech Republic
Democratic Republic of Congo
Republic of the Congo
Dominican Republic
Romania
Russia
Sao Tome and Principe
Serbia and Montenegro
Singapore
Syria
Sudan
Sweden
Switzerland
Thailand
Taiwan
East Timor
Trinidad and Tobago
Tunisia
Turkey
Ukraine
Uruguay
Venezuela
State / Region
*
City
*
Address
*
Postal code
*
City
*
Occupation
*
Employer
*
Identification
VAT Number
*
Type of document
*
Citizen card
Passport
Residence permit
Document number
*
Issuing Entity of Identification Document
Country of Identification Document
*
Afghanistan
South Africa
Germany
Andorra
Angola
Netherlands Antilles
Saudi Arabia
Algeria
Argentina
Australia
Austria
Azerbaijan
Bangladesh
Belgium
Bolivia
Bosnia and Herzegovina
Brazil
Bulgaria
Cape Verde
Cameroon
Canada
Kazakhstan
Chile
China
Cyprus
Colombia
South Korea
Costa do Marfim
Costa Rica
Croatia
Denmark
Egypt
El Salvador
United Arab Emirates
Ecuador
Slovakia
Slovenia
Spain
United States
Estonia
Fiji
Philippines
Finland
France
Ghana
Greece
Guinea
Equatorial Guinea
Guinea-Bissau
Haiti
Netherlands
Hong Kong (China)
Hungary
Solomon Islands
India
Indonesia
Iran
Ireland
Iceland
Israel
Italy
Jamaica
Japan
Jordan
Kosovo
Kuwait
Latvia
Lebanon
Libya
Lithuania
Luxembourg
Malaysia
Morocco
Mexico
Mozambique
Moldavia
Nigeria
Norway
New Zealand
Netherlands
Panama
Pakistan
Peru
Poland
Portugal
Kenya
United Kingdom
Czech Republic
Democratic Republic of Congo
Republic of the Congo
Dominican Republic
Romania
Russia
Sao Tome and Principe
Serbia and Montenegro
Singapore
Syria
Sudan
Sweden
Switzerland
Thailand
Taiwan
East Timor
Trinidad and Tobago
Tunisia
Turkey
Ukraine
Uruguay
Venezuela
Valid until
*
Place of Birth
*
Date of birth
*
Nationality
*
Afghanistan
South Africa
Germany
Andorra
Angola
Netherlands Antilles
Saudi Arabia
Algeria
Argentina
Australia
Austria
Azerbaijan
Bangladesh
Belgium
Bolivia
Bosnia and Herzegovina
Brazil
Bulgaria
Cape Verde
Cameroon
Canada
Kazakhstan
Chile
China
Cyprus
Colombia
South Korea
Costa do Marfim
Costa Rica
Croatia
Denmark
Egypt
El Salvador
United Arab Emirates
Ecuador
Slovakia
Slovenia
Spain
United States
Estonia
Fiji
Philippines
Finland
France
Ghana
Greece
Guinea
Equatorial Guinea
Guinea-Bissau
Haiti
Netherlands
Hong Kong (China)
Hungary
Solomon Islands
India
Indonesia
Iran
Ireland
Iceland
Israel
Italy
Jamaica
Japan
Jordan
Kosovo
Kuwait
Latvia
Lebanon
Libya
Lithuania
Luxembourg
Malaysia
Morocco
Mexico
Mozambique
Moldavia
Nigeria
Norway
New Zealand
Netherlands
Panama
Pakistan
Peru
Poland
Portugal
Kenya
United Kingdom
Czech Republic
Democratic Republic of Congo
Republic of the Congo
Dominican Republic
Romania
Russia
Sao Tome and Principe
Serbia and Montenegro
Singapore
Syria
Sudan
Sweden
Switzerland
Thailand
Taiwan
East Timor
Trinidad and Tobago
Tunisia
Turkey
Ukraine
Uruguay
Venezuela
Marital status
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Single
Committed
Married
Widower
Divorced
I have another nationality
Afghanistan
South Africa
Germany
Andorra
Angola
Netherlands Antilles
Saudi Arabia
Algeria
Argentina
Australia
Austria
Azerbaijan
Bangladesh
Belgium
Bolivia
Bosnia and Herzegovina
Brazil
Bulgaria
Cape Verde
Cameroon
Canada
Kazakhstan
Chile
China
Cyprus
Colombia
South Korea
Costa do Marfim
Costa Rica
Croatia
Denmark
Egypt
El Salvador
United Arab Emirates
Ecuador
Slovakia
Slovenia
Spain
United States
Estonia
Fiji
Philippines
Finland
France
Ghana
Greece
Guinea
Equatorial Guinea
Guinea-Bissau
Haiti
Netherlands
Hong Kong (China)
Hungary
Solomon Islands
India
Indonesia
Iran
Ireland
Iceland
Israel
Italy
Jamaica
Japan
Jordan
Kosovo
Kuwait
Latvia
Lebanon
Libya
Lithuania
Luxembourg
Malaysia
Morocco
Mexico
Mozambique
Moldavia
Nigeria
Norway
New Zealand
Netherlands
Panama
Pakistan
Peru
Poland
Portugal
Kenya
United Kingdom
Czech Republic
Democratic Republic of Congo
Republic of the Congo
Dominican Republic
Romania
Russia
Sao Tome and Principe
Serbia and Montenegro
Singapore
Syria
Sudan
Sweden
Switzerland
Thailand
Taiwan
East Timor
Trinidad and Tobago
Tunisia
Turkey
Ukraine
Uruguay
Venezuela
FATCA Classification*
No, I am not US Person
Yes, I am US Person
Do you hold a political office, or have a family member or partner in a company that is political office holder?
Who and what position?
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Light Account
Plus Account
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Light Account
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I authorize the collection and processing of personal data for conducting marketing activities, including email and SMS, regardless of my intervention:
I authorize LUSOPAY to send all the data collected on this form as well as copies of the identification documents to the company I have been informed that, due to security, the credentials of access to LUSOPAY must be different of the platform
to LUSOPAY
to merchants and LUSOPAY partners.
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I accept the processing of personal data
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