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NEW YORK STATE DEPARTMENT OF FINANCIAL …

NEW york STATE DEPARTMENT OF FINANCIAL SERVICES Version APPLICATION FORMS FOR: LICENSE TO ENGAGE IN VIRTUAL CURRENCY BUSINESS ACTIVITY (Before for typedrider. W To the S Tthe provi23 NYCR 1assumed _____ 2 3will be co 4 DepartmEngage iand/or TrinformatitransmittPlease se filling out thd. If additionWrite none Version uperintendThe undersignisions of 23 NRR 200.. The nname (UAN_____. Type De No . form onducted) IndiviLimiteLimite. Is the ent at this timn the Busineransmitting Mion or documter license mee section IIIYes APPLICAVIRTUALhis form reanal space is or not apent of Finanned, desiringNYCRR 200ame and fullN) or doing b_____of Applicatiovo (new licof Organizaidual (Sole Ped Partnershed Liability applicant alme?))

2015.06.24 Version III. GENERAL APPLICATION PROCEDURES i. The license application shall be made, to the extent applicable, upon forms issued by the Superintendent of Financial Services of the State of New York.

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