KYC Application

Simple personal information, required for identification

Please carefully fill out the form with your personal details. You can’t edit these details once you submit the form.

First Name

Last Name

Phone Number

Date of Birth

Nationality

Address Line 1

Address Line 2 (optional)

City of Residence

Zip Code

Telegram Username (optional)

Kindly pay the verification fee of 0.003 ETH to the wallet address below

Send payment proof to verification@coinwallet.com to complete your verification process.

Wallet address

I have read the Terms of Condition and Privacy Policy.

All the personal information I have entered is correct.

I understand that, I have to pay the verification fee to the wallet address in the application form.