Hatio Payouts - Merchant Onboarding Form

01. Company/Business Information

Company Name
Doing Business As (Trade Name if Any)
Registered Office Address Address

State
PIN Code
Corporate Office Address Address

State
PIN Code
Business Sector/Category Aggregator / Airlines / Association / Automobiles / B2B /
(select any one option) Bank Wallet / Banking / CardNet / Consultancy / Donation /
DTH or Broadband or ISP / Ecommerce / Education / Exami-
nation Board/Financial Service or Broking or Advisory Ser-
vices / Gaming / General Insurance / Government or Munic-
ipal Corporation / Health Insurance / Hotels or Hospitality /
Housing or Real Estate / IT Enabled Services (Software or
Hardware) / Life Insurance / Loan Repayment / Logistics /
Manufacturing / Matrimonial / Media & Publishing / Medi-
cal Services / Mobile Wallets / Municipal Corporation / Mu-
tual Funds / Non-Banking Financial Company / Political
Party / Portal / Stock Exchange / Subscription / Tax Pay-
ments/ Telecom / Tender / Ticketing / Travel /Utility / Other
(please specify)
Date of Incorporation
CIN/LLPIN
Company PAN
GST number

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 Business Description

Number of employees

Company turnover in last FY

Profit after taxes in last FY

Expected Turnover in the current FY

02. Contact details Primary Secondary

Business Name
Telephone/Mobile
Company Email
Technical Name
Telephone/Mobile
Company Email
Financial / Name
Administrative Telephone/Mobile
Company Email

03. Website, App and Social Media details of Company/Product (Provide the URL)
a. Website
b. Google Play Store Link
c. Apple App Store Link
d. LinkedIn Profile
e. Facebook Profile
f. Instagram Profile
g. Twitter Profile
<<Add more rows as required>>

Hatio Payouts – Merchant Onboarding Form

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 04. Payout Requirement
a. Requirement for Payouts (Please describe in de-
tail ALL use cases for Payouts)

b. Name of existing Payouts provider (if any)

c. Current Payout Volumes (Number of Transac-
tions per month)
d. Minimum value of a transaction
e. Maximum value of transaction
f. Average value of transaction
g. Expected Number of Payouts per month

h. Total expected Value of transactions per month

in INR (= Average value * Number of Payouts)
05. Billing details
a. Merchant Name (as it should appear on the in-
voice)
b. Harmonized System of Nomenclature ('HSN') /
Service Accounting Code ('SAC')
c. GST Registration Number
d. GST Registration Date
06. Bank Account details
a. Beneficiary Name
b. Bank Name
c. Bank Account Number
d. IFSC Code

Hatio Payouts – Merchant Onboarding Form

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 07. List of Directors (in case of companies) / Partners (in case of LLP’s)
Sr. Name DIN PAN Executive/Non- Politically Exposed
Executive (PEP) or related to
PEP? (Yes/No)

<<Add more rows as re-

quired>>

08. Authorized Signatory details

Name PAN Politically Exposed (PEP) or related
to PEP? (Yes/No)

<<Add more rows as required>>

09. Ultimate Beneficial Owner (UBO) Details

The following natural person(s) directly or indirectly exercise control or have a controlling interest i.e., hav-
ing ownership/entitlement of more than 10% of shares/capital/profits/property or controlling through voting
rights, agreement, arrangement etc.

Sr. Name PAN % of shares Politically Exposed

(PEP) or related to
PEP? (Yes/No) *

<<Add more rows as

required>>

Signature Organization Stamp

Full Name: Date:

Designation:

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