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Secure Data Collection Form

Investor data collection for Republic investors.


Secure Data Collection Form


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As a Transfer Agent, Securitize LLC requires certain information from you such as your Date of Birth (DOB) and Tax Identification Number (TIN). Securitize will never share this information with any parties without your prior authorization. If you have any inquiries about how we store and protect information, please visit our Company Website and view our Securitize Privacy Policies.


Our partner, Republic, is requesting that Securitize LLC share your DOB and TIN so they don’t need to request your information again if and when you participate in future Republic offerings.



This site is operated by Securitize, Inc. (“Securitize”), which is not a registered broker-dealer. Securitize does not give investment advice, endorsement, analysis or recommendations with respect to any digital securities. All digital securities powered by Securitize’s technology are offered by, and all information related thereto is the responsibility of, the applicable issuer of such digital securities. Neither Securitize nor any of its officers, directors, agents and employees makes any recommendation or endorsement whatsoever regarding any digital securities powered by Securitize’s technology. Nothing on this website should be construed as an offer, distribution or solicitation of any digital securities. Securitize does not provide custodial services in connection with any digital securities powered by Securitize’s technology.