Service Provider A Transfer

Request for Cryptocurrency Withdrawal Limit Increase

If you currently hold at least $40,000 in aggregate of Bitcoin (BTC) and/or Ethereum (ETH) in your PayPal

[and/or Venmo] cryptocurrency hub(s), you may request to make one or more withdrawals that exceed the currently stated weekly limits in your cryptocurrency hub(s) terms and conditions. To make such a request, please carefully complete the form below and send from email associated with your PayPal or Venmo account to ************@******.*** or ************@*****.***. You will receive a response to your request within 7 business days. If your request is approved, you may then initiate your cryptocurrency withdrawal to the wallet address(es) specified below. Customer Name:

(First) (Last)

1. What is your current employment status?

(Check one of the following)

• Employed

• Retired

• Self-Employed / Entrepreneur

• Student

• Not Employed

2. What is your monthly income?

(Check one of the following)

• Up to $5,000

• $5,001 to $10,000

• $10,001 to $20,000

• $20,001 to $30,000

• More than $30,000

3. What is your estimated net worth?

(Check one of the following)

• Up to $50,000

• $50,001 to $150,000

• $150,001 to $300,000

• $300,001 to $500,000

• More than $500,000

4. What is the purpose of this withdrawal?

(Describe why you are requesting an increase of the withdrawal limit) 5. What wallet address do you want your assets transferred to?

(You may provide only one Bitcoin and one Ethereum wallet address) Bitcoin (BTC) Wallet Address: Ethereum (ETH) Wallet Address: 6. What is the amount you want to transfer?

(Specify value in US Dollars for each asset)

Bitcoin (BTC): Ethereum (ETH): 7. Is the wallet address hosted at a crypto exchange and/or service? Bitcoin (BTC) Wallet Address

• Yes

• No

Ethereum (ETH) Wallet Address

• Yes

• No

8. If you answered yes to question 7 for either BTC or ETH wallet, please provide the name of the crypto exchange/service that custodies this wallet and the name of the account holder. Bitcoin (BTC) Wallet Address

Exchange/Service Provider Name: Account Holder Name: Ethereum (ETH) Wallet Address

Exchange/Service Provider Name: Account Holder Name: 9. If you answered no to question 7 for either BTC or ETH wallet, please verify ownership of the self- hosted address(es) specified in question 5 by completing ONE of the following steps:

• Deposit at least $2.00 into your PayPal or Venmo wallet from your self-hosted wallet specified in question 5. If you choose this option, please list the transaction ID(s) for each deposit.

• Validate ownership of self-hosted wallet address through a digital signature by following the steps included in the digital signature instructions document. If you choose this option, please complete the fields below for your BTC and/or ETH wallet address.

(Note: If you are requesting a transfer to a self-hosted wallet address, you must complete this step for both the BTC and ETH wallet address(es), if applicable. This step must be completed before you submit this form. This is a one-time ownership verification process, and you will not be asked to subsequently verify ownership of this wallet address.) BTC Deposit Transaction ID: ETH Deposit Transaction ID: OR

BTC Message: BTC Signature: ETH URL: I do hereby attest that this information is true, accurate and complete to the best of my knowledge.

Signature Date

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