CLIENT APPLICATION FORM (CAF)

IMPORTANT REMINDER: ALL FIELDS ARE MANDATORY. IF NOT APPLICABLE, INDICATE “NA” OR “N/A”.
SERVICE(S) TO BE ENROLLED
(TO BE FILLED-OUT BY PAYMAYA RELATIONSHIP MANAGER)
APPLYING AS: MODE(S) OF PAYMENT & MERCHANT DISCOUNT RATE (MDR): MERCHANT CATEGORY CODE (MCC):
□ Direct Merchant □ PayMaya Checkout MDR: ______% □ PayMaya One MDR: ______% _____________ □ check if High Risk
□ Payment Facilitator (PF) □ Website (API Keys) □ PayMaya Touch MDR: ______% SECURITY DEPOSIT:
□ Third Party Processor (TPP) □ Mobile (SDK) Keys □ PayMaya QR Dynamic MDR: ______% CARD TYPE(S):
□ Independent Sales Organization (ISO) □ Email Invoicing □ PayMaya QR Static MDR: ______% □ Visa □ MasterCard
□ Merchant Referrer (MR) Plug-ins: □ Woocommerce □ Magento □ Shopify □ WeChat QR MDR: ______% □ JCB □ WeChat
PF/TPP/ISO/MR NAME (if referred by □ PayMaya Vault MDR: ______% □ Online P3/MiGS/CTV MDR: ______% □ BancNet □ Others: ____________
PF/TPP/ISO/MR Partners):
□ Pay with PayMaya MDR: ______% □ PayMaya Bills Pay MDR: ______%
SPECIAL ARRANGEMENT(S)/OTHER FEES: CURRENCY(IES):
□ Php □ USD □ Others: ______________
IMPORTANT REMINDER: ALL FIELDS ARE MANDATORY. PLEASE FILL-OUT LEGIBLY, DO NOT LEAVE BLANK FIELDS. IF NOT APPLICABLE, INDICATE “NA” OR “N/A”.
BUSINESS INFORMATION
TYPE OF BUSINESS/ORGANIZATION: □ SMALL MERCHANT □ SOLE PROPRIETORSHIP □ PARTNERSHIP □ CORPORATION □ GOVERNMENT AGENCY OTHERS: ______________________
REGISTERED BUSINESS NAME (50 characters only): TRADE NAME/DOING BUSINESS AS (Required. 21 characters only):

PETRO
MAIN OFFICE ADDRESS (Building, Street No., Street Name, Village/Barangay, City/Province, Zip Code): BUSINESS TIN:

Vinzons Avenue, Brgy 2 Poblacion, Vinzons, Camarines Norte

NATURE OF BUSINESS (GOODS OR SERVICES SOLD): SOURCE OF FUNDS:
MAIN OFFICE MOBILE/LANDLINE NO.: MAIN OFFICE EMAIL ADDRESS: COMPANY WEBSITE URL (For Checkout & Vault):

N/
TOTAL NO. OF AGENT(S)/PARTNER(S): CURRENT ACQUIRING PARTNER(S): UNDERWRITING SUB-MERCHANTS? □ YES □ NO
COUNTRY OF INCORPORATION (If applicable): N/ NUMBER OF □ YEAR(S)|□ MONTH(S) IN BUSINESS:
NAME(S) OF COUNTRY(IES) WITH PRESENCE (If applicable): COUNTRY HEADQUARTERS (If applicable):
N/
CITY(IES)/PROVINCE(S) WITH DOMESTIC BRANCH(ES) (If applicable):

AVERAGE SPEND OF CUSTOMER IN PHILIPINE PESO VALUE: (for start-up business, kindly provide projection or estimate)

AVERAGE NUMBER OF TRANSACTIONS PER MONTH: (for start-up business, kindly provide projection or estimate)

AVERAGE MONTHLY SALES/INCOME IN PHILIPPINE PESO VALUE: (for start-up business, kindly provide projection or estimate)
1,000,00
REGULATORY QUESTIONNAIRE
1. IS YOUR INSTITUTION REQUIRED BY A REGULATORY AUTHORITY TO COMPLY WITH ANTI-MONEY LAUNDERING LEGISLATION? □ YES □/ NO
IF YES, NAME THE REGULATORY AUTHORITY THAT OVERSEES ANTI-MONEY LAUNDERING COMPLIANCE: _______________________________________.
2. IS YOUR BUSINESS PCI-DSS CERTIFIED? □ YES □/ NO
3. WILL YOU SWIPE CREDIT /DEBIT CARDS IN OTHER DEVICES ASIDE FROM THE PAYMAYA POS/TERMINAL? (Ex. Cash Register, Card Reader, etc.) □ YES □ NO
4. WILL YOU TEMPORARILY AND/OR PERMANENTLY STORE PAYMENT CARD AND/OR CARDHOLDER INFORMATION IN ANY OF YOUR □ YES □ NO
SYSTEMS/DATABASES/SERVERS/CLOUD?
IF YES, PLEASE CHECK ALL THAT APPLY: □ CARDHOLDER NAME □ FULL CREDIT CARD NUMBER (16 DIGITS) □ EXPIRY DATE □ CVV/CVC
5. WILL YOU ROUTE PAYMENT CARD AND/OR CARDHOLDER INFORMATION TO ANY THIRD-PARTY SYSTEMS/DATABASES/SERVERS/CLOUD ASIDE FROM □ YES □/ NO
PAYMAYA?
IF YES, PLEASE IDENTIFY THE THIRD-PARTY ENTITY AND IF THEY ARE PCI-DSS CERTIFIED: ________________________________________________________.
6. IS THE TRANSMISSION OF PAYMENT CARD DATA DONE VIA UNSECURED MEANS INTERNALLY AND/OR TO ANY EXTERNAL □ YES □ NO
SYSTEM/DATABASE/SERVER/CLOUD? /
RECORD KEEPING QUESTIONNAIRE
DOES YOUR INSTITUTION RETAIN ALL RECORDS OF CUSTOMER INFORMATION? □ YES □ NO
IF YES, HOW LONG DOES YOUR INSTITUTION SAFE KEEP RECORDS OF CUSTOMER INFORMATION? ____________________. /
INTERCOMPANY AFFILIATIONS
*Please use a separate sheet providing the same details below if with more than one parent and subsidiary company.
PARENT COMPANY NAME: TIN:
N/
PARENT COMPANY’S MAIN OFFICE ADDRESS: N/
SUBSIDIARY COMPANY NAME: TIN:
N/
SUBSIDIARY COMPANY’S MAIN OFFICE ADDRESS:

SOLE PROPRIETOR/PARTNERS/ULTIMATE BENEFICIAL OWNER(S) INFORMATION

IMPORTANT NOTES:
*For CORPORATIONS, 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 GOCCs/NGAs/NGOs/LGUs and COOPERATIVES, kindly identify the Head of the Agency/Organization or Senior Management who ultimately has effective control over the agency/organization.
*Please submit Valid IDs of each below:
*Please use a separate sheet providing the same details below for additional UBOs or OTHERS.

NAME (Last, First, Middle): POSITION/TITLE: % OWNERSHIP:

PERMANENT ADDRESS: SOURCE OF FUNDS:
NATURE OF WORK:
PLACE OF BIRTH: MOBILE/LANDLINE NO.:
DATE OF BIRTH (MM/DD/YYYY): NATIONALITY: Filipin EMAIL ADDRESS:

NAME (Last, First, Middle): POSITION/TITLE: N/ % OWNERSHIP: N/

N/
PERMANENT ADDRESS: SOURCE OF FUNDS: N/
NATURE OF WORK:
N/
PLACE OF BIRTH: MOBILE/LANDLINE NO.:
DATE OF BIRTH (MM/DD/YYYY): N/ NATIONALITY: EMAIL ADDRESS:

NAME (Last, First, Middle): POSITION/TITLE: % OWNERSHIP:

N/
PERMANENT ADDRESS: SOURCE OF FUNDS:
NATURE OF WORK:
PLACE OF BIRTH: N/ MOBILE/LANDLINE NO.: N/
DATE OF BIRTH (MM/DD/YYYY): N/ NATIONALITY: EMAIL ADDRESS: N/
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NAME (Last, First, Middle): POSITION/TITLE: % OWNERSHIP:
PERMANENT ADDRESS: SOURCE OF FUNDS:
NATURE OF WORK: N/
PLACE OF BIRTH: MOBILE/LANDLINE NO.:
N/
DATE OF BIRTH (MM/DD/YYYY): NATIONALITY: EMAIL ADDRESS: N/
NAME (Last, First, Middle): POSITION/TITLE: % OWNERSHIP:
N/
PERMANENT ADDRESS: SOURCE OF FUNDS:
NATURE OF WORK:
PLACE OF BIRTH: MOBILE/LANDLINE NO.:
DATE OF BIRTH (MM/DD/YYYY): NATIONALITY: EMAIL ADDRESS:

APPLICABLE TO CORPORATIONS ONLY:

I hereby declare, under penalty of law, that all matters set forth in this declaration of ownership, including the declaration of ultimate beneficial ownership, have been made in good
faith, and to the best of my knowledge, are true and correct.

___________________________________________________________
PRINTED NAME AND SIGNATURE OF CORPORATE SECRETARY | DATE
IMPORTANT REMINDER: ALL FIELDS ARE MANDATORY. PLEASE FILL-OUT LEGIBLY, DO NOT LEAVE BLANK FIELDS. IF NOT APPLICABLE, INDICATE “NA” OR “N/A”.
THIS SECTION SHOULD BE SUBMITTED WITH ORIGINAL OR WET SIGNATURES.
AUTHORIZED SIGNATORY(IES) AND REPRESENTATIVE(S)
DEFINITION OF CONTACT PERSON’S ROLES:
1. TECHNICAL CONTACT PERSON for Integration and Downtime/System Activities;
2. OPERATIONS CONTACT PERSON/MERCHANT ADMINISTRATOR for PayMaya Manager Access, Settlements, Chargebacks, Disputes, Queries, Additional MID requests (of existing enrolled product, settlement and rates), etc.
IMPORTANT NOTES:
*For SMALL MERCHANTS and SOLE PROPRIETORSHIPS, if authorized signatory is not the owner, kindly fill-out this section and execute a Special Power of Attorney (SPA).
*For the AUTHORIZED SIGNATORY(IES), kindly submit Valid IDs.
*Please use a separate sheet providing the same details below for additional Authorized Signatory(ies) and Representative(s).

ROLE(S): □ Authorized Signatory □ Technical Contact Person □ Operations Contact Person/Merchant Administrator
NAME (Last, First, Middle): DATE OF BIRTH (MM/DD/YYYY): SPECIMEN SIGNATURE (REQUIRED):

PERMANENT ADDRESS:

PLACE OF BIRTH:
POSITION/TITLE: NATIONALITY: MOBILE/LANDLINE NO.:
NATURE OF WORK: SOURCE OF FUNDS: EMAIL ADDRESS:

ROLE(S): □ Authorized Signatory □ Technical Contact Person □ Operations Contact Person/Merchant Administrator
NAME (Last, First, Middle): DATE OF BIRTH (MM/DD/YYYY): SPECIMEN SIGNATURE (REQUIRED):

PERMANENT ADDRESS:

PLACE OF BIRTH:
POSITION/TITLE: NATIONALITY: MOBILE/LANDLINE NO.:
Own Filipin
NATURE OF WORK: Reta SOURCE OF FUNDS: EMAIL ADDRESS:

ROLE(S): □ Authorized Signatory □ Technical Contact Person □ Operations Contact Person/Merchant Administrator
NAME (Last, First, Middle): DATE OF BIRTH (MM/DD/YYYY): SPECIMEN SIGNATURE (REQUIRED):
N/
PERMANENT ADDRESS:

PLACE OF BIRTH:
POSITION/TITLE: N/ NATIONALITY: N/ MOBILE/LANDLINE NO.:
N/
NATURE OF WORK: SOURCE OF FUNDS: EMAIL ADDRESS:
N/
SETTLEMENT INFORMATION
*This is where the Proceeds/Sales/Income will be credited into.

□ IF PREFERRED SETTLEMENT THROUGH PAYMAYA ACCOUNT (Recommended for merchant’s with less than or equal to Php 100,000 monthly transaction volume.)
PAYMAYA ACCOUNT NAME: PAYMAYA ACCOUNT NO.:

□ IF PREFERRED SETTLEMENT THROUGH BANK ACCOUNT (Details should be the same as the Bank Certificate, Passbook, Statement of Account (SOA), etc. submitted.)
BANK NAME: MAINTAINING BRANCH:
ACCOUNT NAME: Ma. Susan Nunez /or Nicolette ACCOUNT NUMBER:
NOTE: FOR ADDITIONAL MIDs AND CUSTOMIZED PAYMENT DETAIL PRIVILEGES, PLEASE CONTACT YOUR ASSIGNED PAYMAYA RELATIONSHIP MANAGER.

CONFORME
By signing this form, I hereby warrant that:
(i) the signatory herein is duly authorized by the corporation/entity which I represent;
(ii) all information stated in this form and supporting documents are true and accurate;
(iii) I have read and understood the terms and conditions herein and as found in the PayMaya Business website (https://www.business.paymaya.com) and I shall strictly comply and abide by these terms and conditions;
(iv) this is a free and voluntary act;
(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 about myself and credit information from the PLDT Group, its subsidiaries, affiliate
banks, credit card companies, and other financial institutions in the course of evaluating my application, and I/we 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 to the PLDT Group and its subsidiaries and its authorized business partners all information 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 PLDT Group and its subsidiaries and its authorized business partners; (c) advertising new products and services being offered by PLDT Group 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.
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.

PAYMAYA INTERNAL APPROVALS

PAYMAYA RELATIONSHIP MANAGER: VALIDATED BY: APPROVED BY:

PRINTED NAME AND SIGNATURE | DATE PRINTED NAME AND SIGNATURE | DATE PRINTED NAME AND SIGNATURE | DATE

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