PayHere + e-Wallet



MERCHANT APPLICATION & AGREEMENT
Serial /Contract No :

Product Type: (Please tick whichever is applicable) e-pay Services Acceptance

Visa/MasterCard Acceptance e-Wallet Acceptance (Please tick whichever is applicable)

1) Kiplepay 4)MCash Payment New Retailer Existing Retailer (e-pay or CardPay/MyDebit)
MyDebit Service Acceptance
2) Boost 5)TnG e-Wallet
Alipay Service Acceptance Account No : Existing TID :
3) Vash 6)
NETS Service Acceptance

Section 1 : Business Information

Retailer/Merchant's Doing Business As (DBA) Name or trading name: Merchant’s Registered Name: Please tick this box if same as DBA or trading name

Current Business Address: Business Company Reg No. : Registered Address : Please tick this box if same as Current Business Address.

(no.P.O.Box)
Contact Name Designation Business Operating From : am / pm
Office Phone Mobile Phone Hours To : am / pm

Fax Email Merchant's website address (if available)

(for e-statement)

Section 2 : Merchant Profile

(Please tick whichever is applicable) If Yes for above, Total Monthly Card Sales Volume in RM:
Type of Ownership Sole Proprietor Partnership Total Monthly Turn Over Sales Volume (cash + cards) in RM:
Corporation (Sdn Bhd / Bhd) Others: Avg Ticket Size in RM: Anticipated Highest Ticket Size in RM:
Type of Goods or Services : Retail Travel Agent Workshop
Past Business history of the current owner :
F&B Dept Store Others (pls specify)
1 From(Yr) To (Yr) Trading Name
Type of Premises: Rented Own
Goods / Services
Type of Outlet HQ,Number of Branches
2 From (Yr) To (Yr) Trading Name
Shop Warehouse
Years in current business : Goods / Services

Do you currently accept Credit Cards ? Yes No 3 From (Yr) To (Yr) Trading Name

Default Routing Option : MyDebit Routing International Debit Routing Goods / Services

PRINCIPALS (Name, I/C Nos. and Designations of Sole Proprietor / Partners / Directors)
1 Name 2 Name

I/C No. I/C No.

H/P No. H/P No.
Designation : Designation :

If more than 2 principals, please provide in a separate sheet of paper.

Terminal Fees & Charges (For Sales Person Use only)

Desktop EDC Desktop GPRS Portable GPRS AirPOS EPOS AIRPOS APP with Contactless
Type of Devices
IP Ethernet -* Switch Box* Network Cable 2M 5M Full Product Retailer Category : (for e-pay only)

Acceptance Mode Static QR Dynamic QR Barcode Reader

Monthly Rental RM Contract Term /Period (Months) Effective Date No of Terminals
Visa/MasterCard % MyDebit (ATM Card) : % Alipay : % NETS : %
MDR
e-Wallet : 1) 1.3 % 2) 0 (Boost)% 3) 1.3 % 4) 1.3 % 5) 1.3 % 6) %

Terminal Deposit RM (Refundable) Processing Fee RM Installation Fee RM Advance Payment RM (for e-pay only)

Payment Mode Chq/IBG Date : Chq No. Chq Amt (RM) Interbank Giro (IBG) IBG Amt(RM) Advance Rental(RM)

MCC MCC Description :

Terminal
Ringgit Malaysia Two Thousand (RM2,000/-) or cost of repair,whichever is higher.
Damage/Lost
Note : Deposit is refundable at the end of the rental period after deduction of RM40 per EDC as retrieval fee and RM10 as termination fee upon return of the EDC Terminal and/or device in good working order
and condition.

Section 3 : Bank Account Information for Transactions Settlement

All payments to merchant will be credited to the following bank account for credit card and/or MyDebit card transactions after deducting the merchant discount fee.
Bank Name: Bank Account Number: Account Holder Name:
For payment terms please refer to the Merchant’s services Term & Conditions.
Timeframe for Payment : 3 Business day from successful settlement.
Please indicate account is : Single signatory
Multiple signatories

Merchant Application Form - Standalone V2 Page 1 of 3


 Section 4 : Retailer Web Reporting (for e-pay e-billing purposes) Serial /Contract No :
OGL Lite User Access Request Form
(A) Retailer Details (Mandatory) For Office Use Only
Email address (will be used as the user name)
Retailer Account
Secureword (to be nominated by merchant & will be displayed on the OGL Lite
login screen)

(B) Authorised OGL Lite user (mandatory) (C) OGL Lite Services Available
Full Name of authorised user as per NRIC/Passport 1) List of Terminals Accounts Inquiry
2) Credit Summary Inquiry
3) Reports Inquiry: - CP58 - Period Sale Invoice
NRIC / Passport Number - Period Detail by Terminal - Statement of Account
Mobile Phone - Period Sale - Summary
Position - Period Summary by Terminal
Note: In any future correspondence related to OGL Lite, GHL / e-pay will inform the
Authorised User specified above 4) Announcement / News from e-pay

DECLARATION FOR OGL LITE ACCOUNT CREATION (e-pay)

1 I/We agree that the person appointed under Section 4B is authorised to perform and effect the OGL Lite services specified under Section 4C on my/our behalf in
relation to the Retailer Account specified under section 4A above.
2 I/We agree that there is no physical delivery for the reports specified under Section 4C item (3) above.

Section 5 : Certificate of Due Authorization ( for corporations -Sdn Bhd / Bhd only)
I/We hereby certify that resolutions were passed at a meeting of at the Board of Directors of Merchant on (DD/MM//YYYY) that
1 The Terms of the Agreement be approved;
2 The signatories whose name and signature appear above be authorized to sign this Merchant Application on behalf of Merchant;
3 Any one or more signatories be authorized to take all other actions and sign all other documents in connection with this Merchant Application; and
4 Details of these resolutions be communicated to GHL Cardpay Sdn Bhd remain in force until an amending resolution shall have been passed by Merchant's Board of
Directors and a Certified copy thereof shall have been received by Acquirer
I further certify that Merchant has the power to enter into and perform this Agreement and that details of the above resolutions have been entered into the Minute’s of merchant and
signed therein by the Chairman of the meeting and are in accordance with Merchant's Memorandum and Articles of Association or equivalent constitutional documents.

X Name :
Signature (Chairman of the meeting)

Section 6 : Personal Guarantee (if applicable)

I/We hereby guarantee to GHL Cardpay Sdn Bhd to, their successors and assigns, the full, prompt, and complete performance of the Merchant and all of the Merchant's obligations
under the Merchant's Services Terms & Conditions, including but not limited to all monetary obligations arising out of the Merchant's performance or non-performance under the
Merchant's Services Terms & Conditions, whether arising before or after termination of the Merchant's Services Terms & Conditions. This guarantee shall not be discharged or
otherwise affected by any waiver, indulgence, compromise, settlement extension of credit, or variation of terms of the Merchant's Services Terms & Conditions made by or agreed to
by the Acquirer, and /or Merchant. I/We hereby waive any notice of acceptance of this guarantee, notice of non-payment or non-performance of any provision of the Merchant's
Services Terms & Conditions by the Merchant, and all other notices or demands regarding the Merchant's Services Terms & Conditions.
I/We agree to promptly provide to the Acquirer and/or any information requested by them from time to time concerning my/our financial conditions(s), business history, business
relationships, and employment information.
I/We have read, understand , and agree to be bound by the Merchant's Services Term & Conditions provided to Merchant and those terms and conditions contained in the Merchant
Application & Agreement.

Signature of Guarantor (please sign below) Name: Identification No. / Passport No.

X , an individual

Signature of Witness (please sign below) Name: Identification No. / Passport No.

X , an individual
Section 7 : Politically Exposed Person (PEP) Declaration
I/We hereby certify to the best of our/my current knowledge as of the date the agreement was signed, there is no known owner, officer, director, or agent which is a current or former
official in the executive, legislative, administrative, military, or judical branch of any government (elected or not); an official of a political party; an executive of a government -owned
commercial enterprise; a family member of any of the above mentioned officials; or a close personnel or professional associate of any of the above mentioned officials.
If you are affiliated with any such person, please identify the owner, officer, director, or agent.

Section 8 : Consent Authorisation

As a Merchant, I/we hereby agree that GHL Cardpay Sdn Bhd and its related companies may forward now and at any future time the data of the Merchant’s business entity,
authorised signatories, directors, partners, owners and key personnel of the company/business to credit bureaus that may include (but not limited to) Central Credit Reference
Information System (CCRIS), Credit Tip Off Service (CTOS), RAM Credit Information (RAMCI) and Credit Bureau Malaysia (CBM) for credit checks and credit listing that may include
trade reference listing for purposes such as opening of account; credit evaluation; credit/account review; credit/account monitoring; debt recovery purposes; legal actions feed;
scoring solutions; legal documentation and/or action consented to a contract of facility granted. GHL Cardpay Sdn Bhd and its related companies may also disclose any information
including the conduct of the business account including its authorised signatories, directors, partners, owners and key personnel of the company/business to credit bureaus at any
time.

Section 9 : Acceptance of Terms & Condition / Merchant Authorization

Please sign below to signify that you have read and understood the Merchant's Services Terms & Conditions attached herewith and that you agree to all terms and conditions
contained therein and herein. Merchant agrees that it will be bound by the terms of this Agreement, as may be modified or amended in the future in accordance with its terms.
a) If you are applying for MyDebit Services Acceptance, your Merchant's Services Agreement, comprising of this Merchant Application & Agreement and Sponsored Merchant
Services Terms and Conditions attached is made between you as a Merchant and GHL Cardpay Sdn Bhd. Initial by Merchant:
b) If you are applying for Alipay Acceptance, your Merchant’s Services Agreement, comprising of this Merchant Application & Agreement and Sponsored Merchant Services Terms
and Conditions attached is made between you as Merchant and GHL Cardpay Sdn Bhd. Initial by Merchant:
c) If you are applying for e-Wallet Acceptance, your Merchant’s Services Agreement, comprising of this Merchant Application & Agreement and Sponsored Merchant Services Terms
and Conditions attached is made between you as Merchant and GHL Cardpay Sdn Bhd. Initial by Merchant:
d) If you are applying for e-pay Services Acceptance, your Merchant's Services Agreement, comprising of this Merchant Application & Agreement and Sponsored Merchant Services
Terms and Conditions attached is made between you as a Merchant and e-pay (M) Sdn Bhd. Initial by Merchant:
e) If you are applying for NETS Service Acceptance, your Merchant's Services Agreement, comprising of this Merchant Application & Agreement and Sponsored Merchant Services
Terms and Conditions attached is made between you as Merchant and GHL Cardpay Sdn Bhd. Initial by Merchant:

Merchant Application Form - Standalone V2 Page 2 of 3

Section 4 : Retailer Web Reporting (for e-pay e-billing purposes) Serial /Contract No :
IF MERCHANT SUBMITS A TRANSACTION, MERCHANT WILL BE DEEMED TO HAVE ACCEPTED THE TERMS & CONDITIONS OF THIS AGREEMENT.
By the signing the Merchant Application and Agreement, merchant agrees and understands;
(a) certifies that all information provided in this Merchant Application & Agreement is true and accurate, Merchant understand that GHL Cardpay Sdn Bhd and e-pay (M) Sdn Bhd
reserves the absolute right to decline this application without giving any reason whatsoever.
(b) authorizes GHL Cardpay Sdn Bhd or e-pay (M) Sdn Bhd to: (i) initiate debit entries to any of the Merchant's Account(s) in accordance with the Merchant's Services Terms and
Conditions and (ii) initiate debit entries to any of the Merchant's Account(s) for the application fees described herein prior to the Acquirer's acceptance and execution of this
Merchant Application & Agreement, which application fees shall be retained by the Acquirer whether or not the Merchant Applications & Agreement is accepted and executed by
the Acquirer;
(c) authorized the financial institution(s) with which any of the Merchant's Account(s) are maintained to honour such debit entries initiated by the Acquirer;
(d) irrevocably authorises the Acquirer to include the Merchant's name, address, contact person name, telephone ans facsimile numbers in any directory (including without limitation
any online directory on an Internet website accessible by public) or promotional material produced in connection with acceptance of Cards.
(e) authorizes the Acquirer to access credit report(s) of Merchant and its principals as part of credit assessment process.
(f) is aware that GHL Cardpay Sdn Bhd is an Acquirer for MyDebit with the Payments Network Malaysia Sdn Bhd ("PayNet"), Alipay with Alipay.com Co Ltd ("Alipay"), Network For
Electronic Transfers (Singapore) Pte Ltd ("NETS"), e-pay (M) Sdn Bhd ("e-pay") and/or the applicable e-Wallet Acceptance offered as per stated in the application form.
(g) understands that GHL Cardpay Sdn Bhd will provide and continue to provide customer support and billing associated technology services.
(h) hereby authorizes GHL Cardpay Sdn Bhd to fund the bank account designated by the Merchant.
(i) understands that by continuing to accept MyDebit, Alipay, NETS, e-pay and /or the applicable e-Wallets Acceptance for payment, Merchant is authorizing GHL Cardpay Sdn Bhd
to make direct deposit of MyDebit , Alipay and /or any of the applicable e-Wallets acceptance funds into an account designated by the Merchant and is agreeing to be bound by
the Merchant's Services Terms and Conditions.
(j) agrees that the Payments Network Malaysia Sdn Bhd ("PayNet") , Alipay.com Co Ltd (“Alipay"), Network For Electronic Transfers (Singapore) Pte Ltd, e-pay(M) Sdn Bhd and /or
any of the applicable e-Wallets will debit an account owned and designated by GHL Cardpay Sdn Bhd:
i) for the discount fees, and other charges incurred in connection with the Merchant transaction processing;
ii) for all chargebacks and adjustments;
iii) for arbritration fees, fines, penalties, etc, charged by the "PayNet", “Alipay”, “NETS”, “e-pay” and /or any of the applicable e-Wallets incurred as a result of the Merchant
transaction processing; and
iv) for any other amounts described in the Merchant's Services Terms and Conditions.
(k) This Agreement shall take effect upon this Merchant Application being signed by GHL Cardpay Sdn Bhd/ e-pay (M) Sdn Bhd as provided below and shall remain in full force and
effect for an initial term of one year and shall be automatically extended for successive one-year period--thereafter, unless earlier terminated according to the terms of this
Agreement.
(l) confirm our acceptance of the terms and wish to participate in the selected payment acceptance.

Section 10 : Notice - Personal Data Protection Act 2010

1. GHL Cardpay Sdn Bhd shall ensure that the collection, use and disclosure of your personal data is consistent with the Malaysian Personal Data Protection Act 2010 ("PDPA")
and the relevant Privacy Laws in place in each jurisdiction that GHL Cardpay Sdn Bhd operates in.
2. It is acknowledged that personal data collected and processed is obtained voluntarily and with your consent.

Section 11 : Signing
I/we hereby declare that all the information provided in this application form is true and correct, and I/we accept the terms and conditions as stated in sections 8 to 11 above; and if
any of the information provided in sections 1 to 7 are found to be incorrect, GHL Cardpay Sdn Bhd/e-pay (M) Sdn Bhd reserves the right to terminate the services provided to me/us,
and GHL CardPay Sdn Bhd/e-pay (M) Sdn Bhd also reserves the right to recover any charges or losses from me/us, arising from the incorrect information provided.

Signed for and on behalf of Merchant : Merchant's Company Stamp : Signed for and on behalf of GHL Cardpay Sdn Bhd and e-pay (M) Sdn Bhd

X X
Name : Name :
Title :   Title :
Date : Date :
(DD/MM/YYYY) (DD/MM/YYYY)

Sales Person Name : Territory (e-pay only) :

Sales Person Signature Sales Person No :

DOCUMENTS CHECKLIST FOR MERCHANT APPLICATION

1 Photocopy of Directors Identity Card (NRIC).

2 First page of latest Bank Statement – If existing business.

3 CA/SA Opening Document (showing company name, account number and address) for New Business – Certified True Copy.

4 Photograph of Premises – Front View, Inside View, Street View & Sign Board.

5 Merchant or Premises Signboard must be clear and bearing with “Dimiliki Oleh”. Sign Board which doesn’t have will required to provide copy of Tenancy Agreement or
Sales and Purchase.

Comments / Recommendations by Sales Person :

Merchant Application Form - Standalone V2 Page 3 of 3