in on Payment Application Data Security Standard (PA-DSS) / PCI-DSS Compliance 41) Do you store card data? ves No (c.g. double swiping, key punching on cash register or Copying card number) 2) Is the Revenue EDC Terminal connected to your system/network/cash register? | ClYes TNo Kindly furnish more details if you have answer “YES” on ANY OF the above questions: Software Vendor Name: Payment Software Name: Software Version: Has the vendor's payment software/application been validated against PA DSS? CYes CNo (if yes, please provide relevant document(s) G. Document to be submitted TINRIC/Passport of all Owners/Partners/Directors/Authorized person (photocopy) Ci Form 6 & D(Sole Prop/Partnership)/Section 68 - Annual Return (Company)/Section 14 (for new register company) (Latest 3 months Bank Statement H, Merchant's Declaration 1. IfWe hereby declare that all information provide therein is correct and hereby given my/our unconditional consent to Revenue Group of Companies (collectively as "REVENUE") to conduct cradit checks, to process credit information, to ‘obtain new information and updates on me/us and/or my/our company{ies)/business{es) from all the available sources, REVENUE shall be notified in writing if there is/are any change(s} on the information provided. 2. Ifwe agree that REVENUE shall reserve the right to approve or reject the applications as REVENUE deems fit without assigning any reason. 3, We have read, understand and be bound to all clauses stated in the Merchant Services Terms and Conditions as spelied ‘out and published at httos://www.evpay.com my/legalagreements.php and acknowledge that these clauses may be ‘moaified by REVENUE from time to time, /We shall always keep myself updated and agrees to be bound by the same by Visiting the above URL. 4. We agree and understand that Revenue Solution Sdn 8h (RSSB) isa registered Payment Facilitator (PF) with Frst Data Merchant Solutions (Malaysia) Sdn Bhd (Fiserv) which allows RSS8 to process Visa/MasterCard transactions under RSS3's sub-merchant platform and be bound to all clauses stated in the Sub-Merchant Processing Agreement/Terms and Concitions that is made available online at_httpsy/www.revpay.com.my/legalagreements php and acknowledge that these clauses may be modified by RSSB from time to time. We shall always keep myself updated and agrees to be bound by the same by visting the above URL. (only applicable for PF applications) 5, We have established and maintain strict controls on money laundering and will not allow the company or any ofits facies to be used a channels for money laundering and shall immediately notify REVENUE of any lapses or breaches in ‘our controls that may potentially breach The Anti-Money Laundering, Anti-Terrorism Financing and Proceeds of Unlawful ‘Activities Act 2001 {“AMLATFPUA") The undersigned below hereby confirms with REVENUE that they are duly authorized by the applicant mentioned under the registered name herein to apply with REVENUE for Merchant facilities and to execute all relevant documents relating to the Merchant faclities and to acknowledge teas ¢ ofthe Merchant Services Terms and Conditions set forth herein REVENUE TECHPARK SDN BHD (COMPANY NO: 10214340) 1No, 53-1, 1st Floor, Bayan Bay, Persiaran Bayan Indah, 11900 Pulaw Pinang, name Bsarn Seo ek Cpe NRIC/Passport No: KK KKK ~ OF — KEY Postion: DD avactow : e ‘ompany Stamp REVENUE/Merchant Processing App Form_Vi.9_20210308 Page dofrev F. Declaration on Payment Application Data Security Standard (PA-DSS) / PCI-DSS Compliance 1) Do you store card data? Oves No (e.g. double swiping, key punching on cash register or Copying card number) 2)Is the Revenue EDC Terminal connected to your system/network/cash register? | Ci Yes No Kindly furnish more details if you have answer “YES” on ANY OF the above questions: Software Vendor Name! Payment Software Name: Software Version: Has the vendor's payment software/application been validated against PA DSS? ClYes CINo (if yes, please provide relevant document(s) G, Document to be submitted CNRIC/Passport of all Owners/Partners/Directors/Authorized person (photocopy) 1 Form B & D(Sole Prop/Pertnership)/Section 68 - Annual Return (Company)/Section 14 (for new register company) D Latest 3 months Bank Statement H. Merchant's Declaration 1, (We hereby declare that all information provided therein is correct and hereby given my/our unconditional consent to Revenue Group of Companies (collectively as “REVENUE") to conduct cradit checks, to process credit information, to ‘obtain new information and updates on me/us and/or my/our company(ies\/ousiness(es) from all the avallable sources, REVENUE shall be notified in writing if there is/are any change(s) on the information provided, 2. fwe agree that REVENUE shal reserve the right to approve or reject the applications as REVENUE deems fit without assigning any reason, 3. We have read, understand and be bound to all clauses stated in the Merchant Services Terms and Conditions as spelled fut and published at_https://www.revpay.com my/legalagreements.pho and acknowledge that these clauses may be modified by REVENUE from time to time. /We shall always keep myself updated and agraes to be bound by the same by Visiting the above URL. 4. We agree and understand that Revenue Solution Sdn Bhd (RSSB) isa registered Payment Faciitator (PF) with First Data Merchant Solutions (Malaysia) Sdn Bhd (Fiserv) which allows RSSB to process Visa/MasterCard transactions under RSS@'s sub-merchant platform and be bound to all clauses stated in the Sub-Merchant Processing Agreement/Terms and Conditions that is made available online at https://www-revpay.com.my/legalagreements.php end acknowledge that these clauses may be modified by RSSB from time to time. /We shall always Keep myself updated and agrees to be ‘bound by the same by visiting the above UAL. (only applicable for PF applications) 5. We have established and maintain strict controls on money laundering and will not allow the company or any ofits facilities to be used a channels for money laundering and shall immediately notify REVENUE of any lapses or breaches in ‘ur controls that may potentially breach The Anti-Money Laundering, Anti-Terrorism Financing and Proceeds of Unlawful ‘Activities Act 2003 ("AMLATEPUA"). ‘The undersigned below hereby confirms with REVENUE that they are duly authorized by the applicant mentioned under the registered name herein to apply with REVENUE for Merchant faclties and to execute all relevant documents relating to the ‘Merchant facilites and to acknowledge the acceptance of the Merchant Services Terms and Conditions set forth herein Ailthored Signatory Name: "NRIC/Passport No: Z Position: Date: Company Stamp REVENUE/Merchant Processing App Form_Vi.9_ 20210308 Poge3of8