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: MONTH AND YEAR STARTED:

MAIN OFFICE MOBILE/LANDLINE NUMBER: MAIN OFFICE EMAIL ADDRESS:
STORE WEBSITE URL (For Online Checkout, Pay with Maya Business, Plug-Ins and Vault): GOODS/ SERVICES SOLD:

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

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

AVERAGE MONTHLY SALES/ INCOME (PHP): AVERAGE NO. OF SALES TRANSACTIONS PER MONTH:
AVERAGE TRANSACTION AMOUNT PER CUSTOMER (PHP):

PREFERRED SETTLEMENT (This is where the Proceeds/Sales/Income will be credited into.)

□ MAYA BUSINESS ACCOUNT (Recommended for merchants with less than or equal to Php 100,000 monthly transaction volume.)
MAYA BUSINESS ACCOUNT NAME: ___________________________________ MAYA BUSINESS ACCOUNT NO.: ___________________________________

□ BANK ACCOUNT (See Field Guide for accepted bank accounts. Details should be the same as submitted Bank Certificate, Passbook, Statement of Account (SOA), etc.)
CURRENCY: □ PHP □ USD BANK NAME: __________________________________ MAINTAINING BRANCH: ________________________________
BANK ACCOUNT NAME: ______________________________________________ BANK ACCOUNT NO.: ___________________________________________________

QUESTIONNAIRE

1. 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
2. Do you have other businesses inside the Philippines? □ YES □ NO
If YES, indicate COMPANY BUSINESS NAME(S) with corresponding ADDRESS:

3. Does your business also have operations outside the Philippines? □ YES □ NO
COUNTRY OF INCORPORATION: ____________________________________________ COUNTRY HEADQUARTERS: ___________________________________________________
COUNTRY(IES) WITH PRESENCE: _______________________________________________________________________________________________________________________________________
CITY(IES)/PROVINCE(S) WITH DOMESTIC BRANCH(ES): _____________________________________________________________________________________________________________

FOR MAYA BUSINESS USE ONLY (To be filled out in agreement with Partner):
SERVICE(S) PF/TPP/ISO/DSO NAME (if referred):
APPLYING AS: □ Direct Merchant □ Direct Biller □ Load/Shop Supplier □ Payment Facilitator (PF)
□ Third Party Processor (TPP) □ Independent Sales Organization (ISO) □ Direct Sales Organization (DSO)
SERVICES TO BE ENROLLED:
ONLINE OFFLINE
Fraud Detection Tool: □ Kount Fee: _____________
□ Maya Terminal MDR: ______%
□Captcha Fee: _____________ Add-Ons: □ Share Treats □ Giftaway
If NOT availing both Tools, indicate name of Partner’s existing
Fraud Detection Tool: _____________________________________________________
□ Maya Terminal Lite MDR: ______%
Add-Ons: □ Share Treats □ Giftaway
□ Maya Checkout MDR: ______% / Fixed _________
□ Tap with Card MDR: ______%
Integration: □ Website □ Mobile □ Plug-Ins
□ Maya QR Dynamic MDR: ______%
Checkout Info Configuration: □ Lite □ Full
□ Maya QR Static MDR: ______%
Checkout Plug-ins: □ WooCommerce □ Magento □ Shopify □ Cafe24
□ WeChat QR MDR: ______%
Chatbot Plug-ins: □ Jumper □ Chatgenie □ IV □ Others: ____________________
□ Invoice Payments MDR: ______%
□ Maya Business Shop Margin: ______%
□ Payment Links MDR: ______%

□ Maya Vault MDR: ______%

□ Maya Bills Pay
□ WeChat Online MDR: ______%

□ Pay with Maya MDR: ______%

□ Online P3/MiGS/CTV MDR: ______%

MERCHANT CATEGORY CODE (MCC): ____________ □ High Risk INSTALLMENT (FIXED RATE): □ YES □ NO
FUND SOURCE(S): □ QR PH □ Visa RATE
ISSUER(S) TENOR
□ GrabPay □ JCB (PER TENOR)

□ GCash □ Bancnet
□ WeChat □ MasterCard
□ AliPay □ AMEX
□ Others: __________________
MODE OF SETTLEMENT: □ Billed □ Charge
CURRENCY(IES): □ PHP □ USD □ Others: _________________
SECURITY DEPOSIT:

SPECIAL ARRANGEMENT(S)/ OTHER FEE(S):

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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, such as the Senior Management (e.g., President, Chief Officers, Vice
President, Treasurer, Board of Directors) or any other person who regularly performs similar functions.
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, or any other person who regularly performs similar functions.

NAME OF OWNER DATE OF BIRTH PLACE OF MOBILE/ SOURCE OF NATURE OF %

RESIDENTIAL ADDRESS NATIONALITY EMAIL ADDRESS POSITION/ TITLE
(Last, First, Middle) (mm/dd/yyyy) BIRTH LANDLINE NO. FUNDS WORK/ BUSINESS OWNERSHIP

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 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 ROLE DATE OF MOBILE/

SIGNATORY/ (Signatory, PLACE OF POSITION/ SOURCE OF NATURE OF
RESIDENTIAL ADDRESS BIRTH NATIONALITY LANDLINE EMAIL ADDRESS SPECIMEN SIGNATURE
REPRESENTATIVE Technical POC, BIRTH TITLE FUNDS WORK/ BUSINESS
Operations POC)
(mm/dd/yyyy) NO.
(Last, First, Middle)

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 CLIENT APPLICATION FORM

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 these 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, 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 Maya Business and/or any person authorized by Maya Business, to obtain relevant and pertinent personal information and credit information about myself
and the entity I represent from Maya Business, 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 Maya Business’s disclosure of information concerning myself or my subscription to these companies;
(vii) I also hereby authorize Maya Business to use and disclose all information to Maya Business’ 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 Maya Business and its subsidiaries and its authorized business
partners; (c) advertising new products and services being offered by Maya Business 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.
(ix) I understand that Maya Business shall rely on this form and agreement to proceed with our application to enter into an agreement with Maya Business, and that the Client
shall bear all liabilities and damages that Maya Business may suffer in relying on this certification.

MAYA BUSINESS 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.

FOR MAYA BUSINESS USE 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.

If referred by ISO/ DSO/ Agent,

________________________________________________________ _________________________________________________ / ______________

PRINTED NAME AND SIGNATURE OF RELATIONSHIP MANAGER | DATE PRINTED NAME AND SIGNATURE OF AGENT | DATE / AGENT CODE

VALIDATED BY: APPROVED BY:

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

ACCEPTED BANK ACCOUNTS FOR SETTLEMENT Guide

For PHP (No savings accounts allowed): • Citibank N.A. • Metropolitan Bank and Trust Co
• Allied Bank • Deutsche Bank • Mizuho Corporate Bank
• ANZ Banking Corporation • Development Bank of The Philippines • Phil Bank of Communication
• Asia United Bank • East West Bank • Phil National Bank
• Banco De Oro Universal Bank • Equitable Banking Corp (PCIB) • Phil Trust Company
• Bangkok Bank • Export And Industry Bank • Phil Veterans Bank
• Bank of America • HSBC • Rizal Commercial Banking Corp
• Bank of Commerce (Panasia Bank) • ING Bank • Security Bank and Trust Company
• Bank of the Philippine Islands • International Exchange Bank
• Bank of Tokyo Ltd. Manila • Intl Commercial Bank Of China For USD:
• Chase Manhattan Bank • Korea Exchange Bank • International Bank (Please Specify Bank Name)
• China Banking Corporation • Land Bank of The Philippines • Banco De Oro Universal Bank
• China Trust (Phils) Commercial • Maybank Phils Inc (PNB Rep Bank)

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

PREFERRED SETTLEMENT
Preferred Settlement The mode of settlement where Maya Business shall credit the amount received from the Business’
transactions
Maya Business Account Name Name registered and declared in the Maya Business account
Maya Business Account No. The mobile number linked to the Maya Business account.
Currency The currency of the bank account.
Bank Name Name of bank where bank account is registered. See Field Guide for accepted bank accounts for
settlement.
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).

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