CLIENT APPLICATION FORM

Please fill out the form legibly. All fields are mandatory unless otherwise indicated. If field is not applicable, please indicate “N/A”.
BUSINESS INFORMATION
REGISTERED BUSINESS NAME (50 characters only): TRADE NAME/ DOING BUSINESS AS (21 characters only):

TYPE OF BUSINESS/ORGANIZATION:
□ CASUAL SELLER □ SOLE PROPRIETORSHIP □ PARTNERSHIP □ CORPORATION □ GOVERNMENT AGENCY □ COOPERATIVE □ OTHERS: _____________________
MAIN OFFICE ADDRESS (Building, Street No., Street Name, Village/Barangay, City/Province, Zip Code): BUSINESS TIN:

NATURE OF WORK/ BUSINESS: GOODS/ SERVICES SOLD:

MAIN OFFICE MOBILE/LANDLINE NUMBER: MAIN OFFICE EMAIL ADDRESS:
STORE WEBSITE URL (For Online Checkout, Pay with PayMaya, Plug-Ins and Vault): MONTH AND YEAR STARTED:

SOURCE OF FUNDS: CURRENT ACQUIRING PARTNER/S (if any):

Will you temporarily or permanently store Payment Card and/or Cardholder Information in any of your systems/ databases/ servers/ cloud? □ YES □ NO
If YES, which information is being stored? Check all that apply: □ Cardholder Name □ Full Credit Card Number □ Expiry Date □ CVV/ CVC

BUSINESS ESTIMATES (For start-up business, kindly provide projection/ estimate.)

AVERAGE MONTHLY SALES/ INCOME (PHP): AVERAGE NUMBER OF SALES TRANSACTIONS PER MONTH:
AVERAGE TRANSACTION AMOUNT PER CUSTOMER (PHP):

SETTLEMENT INFORMATION This is where the Proceeds/Sales/Income will be credited into.

PREFERRED SETTLEMENT
If THROUGH PAYMAYA ACCOUNT:
IF THROUGH BANK ACCOUNT:
□ THROUGH PAYMAYA ACCOUNT (Recommended for merchants with less than or equal to Php 100,000 monthly transaction volume.)
□ THROUGH BANK ACCOUNT (Details should be the same as submitted Bank Certificate, Passbook, Statement of Account (SOA), etc.)
PAYMAYA ACCOUNT NAME: ____________________________ PAYMAYA ACCOUNT NO.: ____________________________
BANK NAME: ____________________________ MAINTAINING BRANCH: ____________________________
BANK ACCOUNT NAME: ____________________________ BANK ACCOUNT NUMBER: ____________________________

FOR PAYMAYA USE ONLY (To be filled up by the Relationship Manager)

SERVICE(S) TO BE ENROLLED PF/TPP/ISO/MR NAME (if referred by PF/TPP/ISO/MR):

APPLYING AS: □ Direct Merchant □ Direct Biller □ Payment Facilitator (PF) □ Third Party Processor (TPP) □ Independent Sales Organization (ISO) □ Merchant Referrer (MR)
SERVICE: MERCHANT CATEGORY CODE (MCC):
□ PayMaya Checkout MDR: ______% □ PayMaya One MDR: ______% _____________ □ High Risk
□ Website (API Keys) □ Email Invoicing □ Mobile (SDK) Keys □ Grabpay □ GCash □ Share Treats □ Giftaway □ PhilQR
SECURITY DEPOSIT:
□ Grabpay □ GCash □ PhilQR □ Alipay □ Others: ____________________________________________________
□ Others: ____________________________________________________ □ PayMaya QR Dynamic MDR: ______%, OR
Checkout Plug-ins: □ Woocommerce □ Magento (PH QR-enabled) 0% for the first __ months, & __% in succeeding

□ Shopify □ Cafe24 □ PayMaya QR Static MDR: ______%, OR CARD TYPE(S), FOR CARD SCHEMES ONLY:

Chatbot Plug-ins: □ Jumper □ Chatgenie □ IV

(PH QR-enabled) 0% for the first __ months, & __% in succeeding □ Visa □ MasterCard
□ WeChat QR MDR: ______% □ JCB □ WeChat
□ Others: __________________________________
□ PayMaya Lite MDR: ______% □ BancNet □ Others: ____________
□ PayMaya Vault MDR: ______%
□ Grabpay □ GCash □ Share Treats □ Giftaway □ PhilQR
□ WeChat Online MDR: ______%
□ Others: ____________________________________________________
CURRENCY(IES):
□ Pay with PayMaya MDR: ______%
□ PayMaya Shop Margin: ______%
□ Online P3/MiGS/CTV □ Php □ USD □ Others: ______________
MDR: ______%
□ PayMaya Bills Pay
SPECIAL ARRANGEMENT(S)/OTHER FEES:

CONFORME
By signing this form, I hereby warrant that:
(i) I am duly authorized as a signatory by the corporation/entity which I represent;
(ii) I have read and understood the Contract/Agreement/ Terms and Conditions herein, and I shall strictly comply and abide by thes e Contract/Agreement/
Terms and Conditions;
(iii) this is my free and voluntary act, and that of the corporation/entity which I represent;
(iv) all information stated in this form, including but not limited to the Business, Signatory and UBO information (as declared in the succeeding page), and
submitted supporting documents are true and accurate copies of the original;
(v) all information stated herein and supporting documents submitted are given by me voluntarily to facilitate the processing and evaluation of my application;
(vi) I hereby authorize PayMaya and/or any person authorized by PayMaya, to obtain relevant and pertinent personal information and credit information about
myself and the entity I represent from PayMaya, its subsidiaries, affiliates, credit card companies, government agencies/ organizations and other financial
institutions in the course of evaluating my application, and I authorize the release of such information by these companies from which my personal data
and credit information are requested. I also consent to PayMaya’s disclosure of information concerning myself or my subscription to these companies;
(vii) I also hereby authorize PayMaya to use and disclose all information to PayMaya’s subsidiaries, affiliates and authorized business partners contained in this
application including the supporting documents submitted, my payment history/behavior, and all information about myself from your advertisers and
business partners, for purposes of: (a) facilitating my application for services which they offer; (b) product and service improvement being offered to me by
PayMaya and its subsidiaries and its authorized business partners; (c) advertising new products and services being offered by PayMaya and its subsidiaries
and its authorized business partners; (d) credit investigation and establishing my creditworthiness; and (e) improving customer experience.
(viii) I hereby acknowledge: (a) The regular submission and disclosure of my basic credit data / Current Subject and Contract Data to the Credit Information
Corporation as well as any updates or corrections thereof; and (b) The possible access to my Current Subject and Contract Data by other entities authorized
by the Credit Information Corporation, and credit reporting agencies duly accredited by the Credit Information Corporation, for the purpose of establishing
my creditworthiness.
(iv) I understand that PayMaya shall rely on this form and agreement to proceed with our application to enter into an agreement with PayMaya, and that the
Client shall bear all liabilities and damages that PayMaya may suffer in relying on this certification.
PAYMAYA PHILIPPINES, INC. shall not be liable for any damage, claim, suit, liability and/or inconvenience brought about by our failure to comply with the
abovementioned Terms and Conditions.

________________________________________________________ ________________________________________________________
PRINTED NAME AND SIGNATURE OF AUTHORIZED SIGNATORY | DATE PRINTED NAME AND SIGNATURE OF AUTHORIZED SIGNATORY | DATE

NOTE: SIGN WITH PRINTED NAME ON THE SPACE PROVIDED ABOVE IF MORE THAN TWO (2) AUTHORIZED SIGNATORIES.

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 CLIENT APPLICATION FORM

BENEFICIAL OWNER INFORMATION SHEET

For CORPORATIONS, the Ultimate Beneficial Owner(s) (UBOs) refers to any natural person/s who ultimately owns (20% or more) and controls the corporation or has ultimate effective control over the corporation.
For COOPERATIVES, LOCAL GOVERNMENT UNITS (LGU), GOVERNMENT OWNED AND CONTROLLED ORGANIZATIONS, NATIONAL GOVERNMENT AGENCIES and NON-GOVERNMENT ORGANIZATIONS (NGO), kindly identify the Head of the Agency/ Organization
or Senior Management (e.g., President, Chief Officers, Vice President, Treasurer, Board of Directors) who ultimately has effective control over the agency/organization.
Mobile/
Name of Owner Date of Birth Nature of Work/ %
Residential Address Place of Birth Nationality Landline Email Address Position/ Title Source of Funds
(Last, First, Middle) (mm/dd/yyyy) Business Ownership
Number

AUTHORIZED SIGNATORY/ REPRESENTATIVE INFORMATION SHEET Refers to persons who are duly authorized to represent the Merchant on specific roles and responsibilities.

Please indicate in the column Role the number corresponding to your designated responsibility:
(1) Authorized Signatory - are those authorized to sign on agreements and other pertinent documents on behalf of the Merchant as determined through the Merchant's Board Resolution or equivalent document.
(2) Authorized Technical POC - are for integration and downtime/ system activities.
(3) Operations POC - are for System User Access, Settlements, Chargebacks, Disputes, Queries, Additional Merchant ID (MID) requests (of existing product, settlement, rate) and other operational concerns. The user access credentials for the Partner/
Merchant/ Biller dashboard will be emailed to the Operations POC.
Name of Signatory/ Mobile/
Date of Birth Place of Nature of Work/
Representative Role Residential Address Nationality Landline Email Address Position/ Title Source of Funds Specimen Signature
(mm/dd/yyyy) Birth Business
(Last, First, Middle) Number

Does your business also have operations outside the Philippines? □ YES □ NO
If YES, please answer the following fields.
COUNTRY OF INCORPORATION: COUNTRY(IES) WITH PRESENCE:

COUNTRY HEADQUARTERS: CITY(IES)/PROVINCE(S) WITH DOMESTIC BRANCH(ES):

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 CLIENT APPLICATION FORM

FOR PAYMAYA ONLY:

I attest that I have conducted proper due diligence of the Merchant, including but not limited to determination of Merchant’s existence and validation of Merchant’s information as correct
and accurate. I further confirm that based on my preliminary evaluation, the Merchant is eligible to be onboarded for the services as indicated herein, subject to further review and
evaluation of the requirements they submitted.

________________________________________________________
PRINTED NAME AND SIGNATURE OF PAYMAYA RELATIONSHIP MANAGER | DATE

VALIDATED BY: APPROVED BY:

AGENT 1 / ROBERT DE LA PAZ -OM-
PRINTED NAME AND SIGNATURE | DATE PRINTED NAME AND SIGNATURE | DATE

FIELD GUIDE

SOURCE OF FUNDS Guide

• Investment • Business • Remittance • Loan Proceeds

• Employment • Allotment • Inheritance • Deposits

NATURE OF WORK/ BUSINESS Guide

• Accounting / Bookkeeping / Tax Practice / Services • Lawyer (private practice)

• Advertising / Marketing / Sales Activities • Legal Practice
• Agriculture / Hunting / Forestry / Animal Farming / Fishing • Leasing / Rental Activities (e.g. land, building, machinery, etc.)
• Architect • Medical Services (includes caregiving)
• Beauty and Health Services (e.g. spa, beauty parlors, fitness • Manufacturing (non-food, e.g. garments, vehicles, jewelry, heavy equipment,
centers) etc.)
• Banking • Military - NP
• Business Process Outsourcing (e.g., call centers, billing / credit / • Mining
collections, etc.) • Manning or Employment Agencies - Foreign
• Brokerage • Manning or Employment Agencies - Local
• Charities • Foundation (NGO)
• Commodities Trader • Other Professional Services (e.g. delivery, photography, catering, interior
• Communication (telecommunications includes postal) design, fashion, design styling, etc.)
• Consultancy (e.g. computer-related consultancy- • Publishing / Printing / Reproduction of Recorded Media
hardware/software, technical engineering/architectural, scientific • Pawnshop
related consultation, business consultancy) • Recycling
• Construction (e.g. building, plumbing, electrical, carpentry) • Real Estate (e.g. development, sales)
• Doctor / Dentist (private practice) • Remittance Agent
• Education (including private tutorials, special education) • Religious Organizations
• Embassies / Foreign Consulates • Repairs Services
• Engineer (private practice) • Sanitation / Cleaning / Housekeeping Services (e.g. janitorial services, building
• Entertainment (recreational / cultural / sporting services) (e.g. party maintenance, laundry, etc.)
planning services, event organizing, carnival rides rental, fireworks, • Maritime or Shipping
displays, media network, film production, etc.) • Tourism (e.g. hotels, inns, resorts, restaurants)
• Food Industry / Food Manufacturing / Food Preparation / Processing • Travel and/or Tours Agency
/ Food Packaging • Wholesale / Retail Trade
• Financial Services • Transport (air, water or land)
• FX Dealer / Money Change • Utilities (electricity, gas and water supply)
• Gaming Clubs / Casino • Collection, Purification and Distribution of Water
• Government Service – NP • Others (please specify)
• Insurance Activities

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 CLIENT APPLICATION FORM

CLIENT APPLICATION FORM: DESCRIPTION OF FIELDS

Field Name Description

BUSINESS INFORMATION
Type of Business Organization The type of organizational structure of your business. The choices are indicated in form.
Registered Business Name The Business or Legal Name as indicated in your registration documents to the Department of Trade and Industry (DTI),
Securities and Exchange Commission (SEC) or the governing authority where your business is registered.
Trade Name/ Doing Business As The operating Name of your business as publicly recognized. May be different from the Name registered with DTI, SEC or
other governing authorities.
Main Office Address The address of your head office/ headquarters, serving as the administrative center of the business.
Business TIN The Tax Identification Number of the Business, as registered with the Bureau of Internal Revenue (BIR).
Nature of Work/ Business The type of business based on the kind of goods and services sold. The guide to possible answers on this field is indicated
in the last page.
Goods/ Services Sold The general description and kind of the goods or services sold by the business.
Main Office Mobile/ Landline Number The contact number of your main/ head office.
Main Office Email Address The email address of your main/ head office
Store Website URL The website link/ address of your shop/ store where the online payments shall be made
Month and Year Started The month and year that the Business has been established and became operational, as stated in your registration
documents with DTI, SEC or governing authorities.
Source of Funds The type of fund source where the Business obtains funding for its operations and activities. The guide to possible answers
on this field is indicated in the last page.
Current Acquiring Partner/s Other partners from which the Business has availed Acquiring services such as Point-of-Sale (POS) Terminals, QR Codes,
Online Checkout, etc.

BUSINESS ESTIMATES
Average Number of Transactions per Month Average number of transactions made by customers within a month.
Average Transaction Amount per Customer (PHP) Average estimate spend of customers per transaction in Philippine Peso.
Average Monthly Sales/ Income (PHP) Average of total sales/ income from transactions made within a month, in Philippine Peso.

SETTLEMENT INFORMATION
Preferred Settlement The mode of settlement where PayMaya shall credit the amount received from the Business’ transactions
PayMaya Account Name Name registered and declared in the PayMaya account
PayMaya Account No. The mobile number linked to the PayMaya account.
Bank Name Name of bank where bank account is registered.
Maintaining Branch The branch-of-account of the Bank where account is maintained.
Bank Account Name Name registered and declared as owner of the bank account.
Bank Account Number Designated account number of the bank account.

BENEFICIAL OWNER/ AUTHORIZED SIGNATORY/ REPRESENTATIVE INFORMATION

Name The given name of the beneficial owner, authorized signatory or representative of the Business, in the format: Last Name,
First Name, Middle Name.
Residential Address The address where the person resides on a permanent basis.
Date of Birth The birth date of the person in the format mm/dd/yyyy. This should match the registration and/or identification
documents submitted.
Place of Birth The place where person was born. Should also match information in the documents submitted, if indicated.
Nationality The person’s legal citizenship.
Mobile/ Landline Number The person’s contact number.
Email Address The person’s email address which may be used to contact them.
Position/ Title The person’s position and/or job title in the Business.
Source of Funds The type of fund source where the person earns and generates capital/ savings. The guide to possible answers on this
field is indicated in the last page.
Nature of Work/ Business The type of work/business of the person based on their main source of funds. The guide to possible answers on this field is
indicated in the last page.
% Ownership This is the percentage of ownership of the declared beneficial owners of stock corporations as declared and computed
in the Latest General Information Sheet of the Business.
Role The role of the person as a signatory or representative of the Business, as indicated in the instructions (i.e., Authorized
Signatory, Tech POC, Operations POC).

OTHER INFORMATION
Country of Incorporation
Country Headquarters
Country/ies with Presence
City/ Province with Domestic Branches
For foreign partners only. The country where the Business is incorporated and governed.
For foreign partners only. The country where the main office of the Business is situated.
For foreign partners only. The country/ies where the Business conducts operations.
For foreign partners only. The cities/ provinces in the Philippines where the Business has branches/ outlets.