MERCHANT ENROLLMENT FORM FOR POINT OF SALE SERVICES (POS)

Branch:……………………………… Branch Code ………… RO Code ………………Date……………

Kindly fill up all the columns * indicates a foot note
1 Merchant Account Name *

2 Doing Business Name

3 Constitution Individual/Proprietorship/Partnership/Private Company/Public

Company/Other(Please specify)
4 Doing business since

5 Name of
proprietor
/partners/directors

6 Primary Account Number *

7 Date of opening of account

8 Account Type SB/CD/OD/CCOL

9 Average balance in the a/c

for the last 12 months *
10 Increase in average
balance in the account
envisaged due to
installation of POS
terminal *
11 Number of POS terminals
required *
12 Official/Registered
Address

13 Contact Details For technical matters For bank related matters

 Contact person
name
 Contact
number(Landline)
 Contact
number(Mobile)
14 Address at which POS
terminal is to be installed,
if different from the Official
address:

15 Email ID *

16 Type of Business Computer Hardware/Drug Store/ Electrical/ Electronics/ Fuel/

Hospital/Hotel/Jewellery/Restaurant/Stationery/Super market/
Textiles/Tour Operator/Others (Please specify)
17 Merchant Type Stand alone / Chain store / Company showroom/ Distributor /
Other (Please specify)
18 Business Hours * ............ am to …………….. pm

19 Expected Turnover of INR ………………. per terminal per month

business through the POS
terminal *
20 Details of existing POS
terminal details (Bank, No.
of terminals, Transaction
Volume, MDR etc)

If there are no POS

terminals at present, kindly
specify whether you had a
terminal previously and the
reason why the same was
discontinued.
21 Sales details:  Annual sales turnover: INR ……
 % of sales through cards: ……..%
 Average card transaction size: INR ………
 Daily average no. of card transactions: ………..
transactions
22 % mix of sales through  Immediate delivery of goods: ………%
cards:  Accepting advance and delivery later: ……….%
 Services: ………………%
 Others (Please specify): …………..%
 Total: 100%
23 Premises  Owned/Leased

 Stand alone shop / Shopping Complex

24 FIRC Requirement Yes/No

*
1) As appearing on the Account statement.
6) Primary account is the account which will be credited with the proceeds of POS originated
transactions. Charges will be debited to this account.
9) May be ascertained from the branch. If the account is less than 12 months old, say 5 months,
average balance for 5 months may be reported. If the account is less than 1 months old, the projected
average balance may be reported.
10) If an increase in the average balance is not expected, ‘NIL’ may be mentioned. Only the increase
in average balance that can be attributed to the installation of the POS terminal needs to be reported
here. In other words, increase due to other factors like expansion of business, upcoming festival
season etc need not be reported.
11) If multiple terminals are requested, the table given below may be used for specifying the Address
at which the terminals are to be installed, the Contact details (if different for different locations) and
the Account Numbers (if different for different terminals). The accounts can be opened in any our
branches as per the convenience of the customer.
15) Transaction statement will be sent to this email ID
18) Bank may choose, at its discretion, to block transactions originating after business hours so as to
reduce the incidences of fraud.
19) Bank may decide to levy a nominal charge in case of very large deviations from expected turnover

Additional Locations
Sl Address Contact person Account Number to
details be linked
 Merchant declaration

I/We would like to avail The South Indian Bank Ltd's Point of Sales (POS) services and confirm that
the information given by me/us is true and complete and forms the basis for enrollment for this
service. I/We further declare that I/We have read and agree to be bound by the terms and conditions
mentioned in the agreement, which will be executed prior to availing the service, as amended from
time to time. If at any stage the Bank comes to know that the information provided herein is incorrect
and/or misleading, the Bank reserves the right to terminate the agreement and the service provided
under the agreement. I/We authorize the Bank to verify my/our credentials or make any references
required in respect of enrollment for POS service. I/We understand that the Bank may from time to
time give any credit and other information about me/us, including information on this form, to or
receive such information from any credit bureau, reporting agency, person with whom I/We may have
or propose to have financial dealings. I/We authorize you to credit/debit our Account with South Indian
Bank with the transaction amount, MDR, other charges and service tax as per the agreement. I/We
authorize The South Indian bank Ltd. to debit a higher MDR for transactions using premium branded
cards like platinum cards etc. I/We confirm that the signatory (ies) of this application has/have the full
legal authority to sign this form on behalf of the Merchant Establishment. I/We understand that the
Bank reserves the right to reject the application without assigning any reason whatsoever.

Place: Name of signatory: Signature with seal:

Date: Name of signatory: Signature with seal:

For Branch Use

I hereby certify that the merchant is fully KYC compliant. I have personally visited the premises at
which the terminals are proposed to be installed and have found them satisfactory. The merchant
premises have the potential appearance to attract card holders and appear to be capable of the
projected business through POS terminals. Local enquiries have not revealed any adverse feature
pertaining to the reputation of the merchant. I have adhered to/will adhere to all the instructions and
guidelines mentioned in the bank’s POS Merchant acquiring policy. I hereby recommend the
deployment of POS terminals as per details given below:

No. of terminals: MDR: Monthly rental: Other charges (if any):

Deviations from POS Merchant acquiring policy, if any:

Remarks (If any):

Date: Name of Principal Officer: Signature with seal:

 For RO Use

Recommendations Number of terminals: MDR: Rentals: Other charges:

Recommendation on deviations requested, if any:

Remarks, if any:

Date: Name of Recommending Officer: Signature with seal:

For HO Use

Sanctioning authority:

Sanction reference:

Sanction details No. of terminals: MDR: Rentals: Other charges:

Profitability

Level 1: Direct profit/loss estimated per terminal:

Level 2: Estimated profit/loss if increase in SB/CD balance is also considered:

Level 3: Estimated profit/loss if total balance in SB/CD balance is considered:

Remarks (if any):

Date: Name of Authorized Officer: Signature with seal: