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Bulkpayment Application Forms and TermsConditions - COMBINED

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J Mwa2
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90 views2 pages

Bulkpayment Application Forms and TermsConditions - COMBINED

Uploaded by

J Mwa2
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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BULK PAYMENT APPLICATION FORM

Company profile.
Company Name: ..........................................................................................................................................................................
Physical Address of the Company: .................................................................................................................................................
Postal Address:……………………….............................................. Postal Code: ...............................................................................
Official Tellephone No.1:........................................................... Official Tellephone No.2:.............................................................
Official Email Address:............................................................... Town:.........................................................................................
V.A.T Number:.......................................................................... PIN Number:...............................................................................
Type of Business:....................................................................... Region:.......................................................................................
Trading for: Years Months Proposed name for M-PESA account:...........................................

Type of services requested (Tick relevant box)

SME Bulk payment Managed disbursments Bulk payment

Reason for M-PESA

Disbursment of funds Describe the reason:..................................................................................................................

Contact details
Name of contact person: ...............................................................................................................................................................
Email Address:.......................................................................... Tellephone Number:.....................................................................
Name of Administrator:..................................................................................................................................................................
User Name:.............................................................................. Email Address:.............................................................................

Payment details: Where would you like to receive funds collected?


Bank Account
Name of Bank:……………………….............................................. Branch:.......................................................................................
Account Name:……………………….............................................. Account Number:.........................................................................

Customer declaration
Signed this:………………………..............................Day............of............20:.................... Location...................................................
Authorised signatory name:………………………................................................................................................................................
Designation............................................................................... Branch:.......................................................................................
2nd signatory name:………………………............................................................................................................................................
Designation............................................................................... Branch:.......................................................................................
By signing this form, I/We accept the terms and conditions for M-PESA services.

For official purpose only


Account Manager...................................................................... Sales Executive:...........................................................................
Sector:...................................................................................... Territory Manager:......................................................................

Form to be returned to the enterprise Business Unit, Safaricom House.


NOTE: Information provided on this form will be used to set up your M-PESA account.
Safaricom reserves the rights to accept or reject this request. Terms and Conditions apply

Simple • Transparent • Honest FOR YOU Safaricom PLC I P.O. Box 66827-00800 I Nairobi, Kenya I +254 722 003 272 I www.safaricom.co.ke
M-PESA BULK PAYMENTS (B2C) CONTRACT TERMS AND CONDIOTIONS

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