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
□ PayMaya Vault MDR: ______% □ Online P3/MiGS/CTV MDR: ______% □ BancNet □ Others: ____________
□ Pay with PayMaya MDR: ______% □ PayMaya Bills Pay MDR: ______%
CURRENCY(IES):
OTHER FEES: ___________________________________________________________________ □ 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”.
CLIENT 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 (if different from registered business name, 21 characters only):
MAIN OFFICE ADDRESS (Building, Street No., Street Name, Village/Barangay, City/Province, Zip Code): TIN:
GOODS OR SERVICES SOLD/NATURE OF BUSINESS: SOURCE OF FUNDS:
MAIN OFFICE MOBILE/LANDLINE NO.: MAIN OFFICE EMAIL ADDRESS: COMPANY WEBSITE URL (For Checkout & Vault):
TOTAL NO. OF DOMESTIC BRANCHES:____ NO. OF COUNTRIES WITH PRESENCE:____ NO. OF AGENTS/PARTNERS:____ UNDERWRITING SUB-MERCHANTS? □ YES □ NO
CURRENT PROVIDERS/PARTNERS IN THE PHILIPPINES (Acquirers/Major Banks/Remittances/Pawnshops/Others):
MERCHANT DISCOUNT RATE WITH YOUR CURRENT PROVIDERS/PARTNERS (%) (If applicable):
AVERAGE TICKET SIZE PER TRANSACTION (Amount):
AVERAGE TRANSACTION COUNT PER MONTH:
AVERAGE TRANSACTION VOLUME PER MONTH (Amount):
AVERAGE CARD SALES PENETRATION (% of payment card sales vs. % of cash/check/direct deposit):
AMOUNT OF INTERNATIONAL SALES (If applicable):
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
PARENT COMPANY NAME: TIN:
PARENT COMPANY’S MAIN OFFICE ADDRESS:
SUBSIDIARY COMPANY NAME: TIN:
SUBSIDIARY COMPANY’S MAIN OFFICE ADDRESS:
SOLE PROPRIETOR/PARTNERS/ULTIMATE BENEFICIAL OWNER(S)/INCORPORATORS INFORMATION
*For Corporations, Ultimate Beneficial Owner/s (UBO) refers to any natural person/s who ultimately owns and controls the corporation or has ultimate effective control over the corporation.
NAME (Last, First, Middle): % OWNERSHIP: PERMANENT ADDRESS:
POSITION/TITLE: NATIONALITY:
MOBILE/LANDLINE NO.: SOURCE OF FUNDS: PLACE OF BIRTH:
EMAIL ADDRESS: NATURE OF WORK: DATE OF BIRTH (MM/DD/YYYY):
NAME (Last, First, Middle): % OWNERSHIP: PERMANENT ADDRESS:
POSITION/TITLE: NATIONALITY:
MOBILE/LANDLINE NO.: SOURCE OF FUNDS: PLACE OF BIRTH:
EMAIL ADDRESS: NATURE OF WORK: DATE OF BIRTH (MM/DD/YYYY):
NAME (Last, First, Middle): % OWNERSHIP: PERMANENT ADDRESS:
POSITION/TITLE: NATIONALITY:
MOBILE/LANDLINE NO.: SOURCE OF FUNDS: PLACE OF BIRTH:
EMAIL ADDRESS: NATURE OF WORK: DATE OF BIRTH (MM/DD/YYYY):
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NAME (Last, First, Middle): % OWNERSHIP: PERMANENT ADDRESS:
POSITION/TITLE: NATIONALITY:
MOBILE/LANDLINE NO.: SOURCE OF FUNDS: PLACE OF BIRTH:
EMAIL ADDRESS: NATURE OF WORK: DATE OF BIRTH (MM/DD/YYYY):
NAME (Last, First, Middle): % OWNERSHIP: PERMANENT ADDRESS:
POSITION/TITLE: NATIONALITY:
MOBILE/LANDLINE NO.: SOURCE OF FUNDS: PLACE OF BIRTH:
EMAIL ADDRESS: NATURE OF WORK: DATE OF BIRTH (MM/DD/YYYY):
NOTE: ATTACH ADDITIONAL PAGE IF MORE THAN FIVE (5) PARTNERS, UBOs OR INCORPORATORS.
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.
CLIENT’S AUTHORIZED SIGNATORY(IES)
*If more than two (2) authorized signatories, please use a separate sheet providing the same details below.
NAME (Last, First, Middle): POSITION/TITLE: SPECIMEN SIGNATURE (REQUIRED):
PERMANENT ADDRESS: DATE OF BIRTH (MM/DD/YYYY):
EMAIL ADDRESS: NATIONALITY:
MOBILE/LANDLINE NO.: GOV’T ISSUED ID AND EXPIRY: TIN:
NAME (Last, First, Middle): POSITION/TITLE: SPECIMEN SIGNATURE (REQUIRED):
PERMANENT ADDRESS: DATE OF BIRTH (MM/DD/YYYY):
EMAIL ADDRESS: NATIONALITY:
MOBILE/LANDLINE NO.: GOV’T ISSUED ID AND EXPIRY: TIN:
CLIENT’S AUTHORIZED REPRESENTATIVE(S)
TECHNICAL CONTACT (for Integration and Downtime/System Activities)
*For additional representatives, please use a separate sheet providing the same details below.
NAME (Last, First, Middle): POSITION/TITLE: SPECIMEN SIGNATURE (REQUIRED):
PERMANENT ADDRESS: DATE OF BIRTH (MM/DD/YYYY):
EMAIL ADDRESS: NATIONALITY:
MOBILE/LANDLINE NO.: GOV’T ISSUED ID AND EXPIRY: TIN:
OPERATIONS CONTACT/MERCHANT ADMINISTRATOR (for PayMaya Manager Access, Settlements, Chargebacks, Disputes, Queries etc)
*For additional representatives, please use a separate sheet providing the same details below.
NAME (Last, First, Middle): POSITION/TITLE: SPECIMEN SIGNATURE (REQUIRED):
PERMANENT ADDRESS: DATE OF BIRTH (MM/DD/YYYY):
EMAIL ADDRESS: NATIONALITY:
MOBILE/LANDLINE NO.: GOV’T ISSUED ID AND EXPIRY: TIN:
SETTLEMENT INFORMATION
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: 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 ([Link] 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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