diff --git a/src/routes/open/components/SafeNameForm/index.jsx b/src/routes/open/components/SafeNameForm/index.jsx
new file mode 100644
index 00000000..71f506b7
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+++ b/src/routes/open/components/SafeNameForm/index.jsx
@@ -0,0 +1,21 @@
+// @flow
+import * as React from 'react'
+import Paragraph from '~/components/layout/Paragraph'
+import OpenPaper from '../OpenPaper'
+
+const SafeNameForm = () => () => (
+  <OpenPaper>
+    <Paragraph size="md" color="primary">
+      This setup will create a Safe with one or more owners. Optionally give the Safe a local name.
+      By continuing you consent with the terms of use and privacy policy.
+    </Paragraph>
+    <Paragraph size="md" color="primary" weight="bolder">
+      &#9679; I understand that my funds are held securely in my Safe. They cannot be accessed by Gnosis.
+    </Paragraph>
+    <Paragraph size="md" color="primary" weight="bolder">
+      &#9679; My Safe is a smart contract on the Ethereum blockchain.
+    </Paragraph>
+  </OpenPaper>
+)
+
+export default SafeNameForm