Merchant Information Sheet

Zip Code

Payment Method (Please Select)

Special / Mailing Address (For Centralized Delivery of CWT)

Full Name (Last, First, Middle) Date of Birth (mm/dd/yyyy) Civil Status

Mobile Tel. No. e-Mail Address Website

Name of Company Signatory/ies

Settlement Account No. (For Crediting Payment)

Single Prop. (WI 156) Partnership/Corporation (WC 156)

This form is for BDO use only. Please write legibly and avoid using abbreviations.

Name of Principal Owner

Tel. No.

New Affiliation

Addt’l / Location (Ref. MID/TID _______________________)

Check Issuance Auto-Credit

Fee Account (TPP Only)

MC Assigned ID (For SM Dept. Store)

Peso Dollar

Tax Code (Please Select)With Tax Tax Exempt

FOR BDO USE ONLY (Pay Delay Days)

Tax Number / TIN Tax type (Please select)

Settlement Account No.(For Crediting Payment)

Payees Name (If Check Payment) Report Distribution (e-Mail Address)

Zip Code

With Existing Acquirer?If Yes, Name of Institution

Do you / will you store / transmit card data?If Yes, Specify type of data

Merchant Discount Rate:

BDO Debit Card _________% Expressnet (EN) _________% MegaLink (ML) _________% BancNet _________% Others _________%

Tel. No.

Living with Parents

Spouse’s Tel. No.

BANK REFERENCES

Name of Financial Institution & Branch

Type of Account

Account Number

By signing below, I certify that the information given by me is true and correct and that any material misrepresentation or falsity therein shall be construed as an act to defraud BDO for which civil and / or criminal liability can be pursued against me. I hereby authorize BDO to (i) inquire about and investigate all the declared information from whatever sources BDO mayconsider appropriate; (ii) use any contact details to communicate to me for whatever purpose. I agree to indemnify and hold BDO free and harmless from any and all claims, liabilities, damages, suits or causes of action of whatever nature, now or hereafter arising from or in foregoing authorization.

PRINTED NAME/S POSITION/S SIGNATURE/S DATE

Customer No.

Owning MID

Please select type of Request Monitor(Affil Code)

MCC Sales SlipHandling

MCVCJCACCC

JC Only

Card Plans / Styles

PC Only

MC Only

AC Only

Others ___________________________

VC Only

CC Only

BDM or Agent(AE Code)

Currency Code

Default Transaction Src(For E-Commerce / MOTO / RPS Only)

Area Mall Code: Imprinter Others (Class Code):

PLEASE SELECT TYPE OF MID TO BE USED

Straight MID

UnionPay

Regular Installment MID

0% Installment MID

Regular BNPL Installment MID

0% BNPL Installment MID

Service Fee Rate

MC ___________________

VC ___________________

JC ___________________

AC ___________________

CC ___________________

PC ___________________

SFCC (For MDRs NOT alike) Minimum Service Fee Code

New Paper (If Service Fee Contract is BLANK)

Blank (If Service Fee Contract has a value)

Status

Active Inactive

Status

ActiveInactive

Major Purchase

Yes

Yes

Yes

Yes

Major Purchase

Merchant Group Code

Merchant Group Code

Min. Svc. Fee

Blank

Min. Svc. Fee

New Paper

Status

Active Inactive

Status

Active Inactive

Major Purchase

Major Purchase Merchant Group Code

Merchant Group Code Svc Fee Rate

0.01

Svc Fee Rate

0.01

Svc Fee Rate

0.01

Svc Fee Rate

0.01

SFCCBalanceTransfer

SFCC

Balance Transfer

SFCC

Blank

SFCC

Blank

Min. Svc. Fee

Blank

New Paper

Min. Svc. Fee

Merchant MP Promo Group

Merchant MP Promo Group

REMARKS

FOR ACCREDITATION AND MAINTENANCE USE ONLY

Prepared By / Date:

Approved By / Date:

Encoded By / Date:

Checked By / Date:

Printed Date: 03/2012

Check Delivery Code:

Registered Business No. Admin. (Contact Person)

Yes No

Yes No

Yes No

Has Existing Electronic Cash Register?If Yes, State Name of Service Provider

No. of POS for this Outlet

Residence AddressZip Code

Owned Rented

Spouse’s Name (Last, First, Middle)

Spouse’s Complete AddressZip Code

Name of Financial Institution & Branch

Type of Credit Facility

Loan Amount

Term

Name of Customer / Supplier

Contact Person

Contact Number

Business / Legal Name

DBA (Branch / Trade Name)

REQUIRED FOR SINGLE PROPRIETOR (Principal Details)

FOR BDO USE ONLY

DEBIT FACILITY INSTRUCTIONS

BANK REFERENCES

CREDIT REFERENCES

TRADE REFERENCES

DECLARATION (Please read before signing)

FOR BDO USE ONLY

PLEASE SELECT TYPE OF MID TO BE USED

Prepared By:

Date:

Noted By / Date:

Date:

______________________________________________________________________________________________________________________________________________________________________________

DBA (Branch / Outlet Address)

Manual

For MOTO OnlyeMOTOKey-in

MID Capping:

Documents Required

A. For Single Proprietorship1. Photocopy of DTI Business Registration Certificate2. Original and notarized, with dry seal on all pages, Special Power of Attorney (if signed by person other than the registered owner) with specimen signature3. Photocopy of BIR Certificate of Registration4. Local government permits and licenses (e.g. Mayor’s Permit, etc.)5. Photocopy of one (1) valid ID* with specimen signature of the owner and spouse (if the latter is authorized to transact in behalf of the former)

B. Partnership1. Photocopy of SEC Certificate of Registration2. Photocopy of Articles of Partnership or latest available General Information Sheet3. Photocopy of BIR Certificate of Registration4. Original and notarized, with dry seal on all pages, Partnership Resolution with specimen signature/s5. Local government permits and licenses (e.g. Mayor’s Permit, etc.)6. Photocopy of one (1) valid ID* of each signatories authorized by the partnership to enter into an agreement with BDO as specified in the Partnership Resolution

C. Corporation1. Photocopy of SEC Certificate of Registration2. Photocopy of Articles of Incorporation and By-Laws or latest available General Information Sheet 3. Photocopy of BIR Certificate of Registration4. Original and notarized, with dry seal on all pages, Board Resolution or Secretary’s Certificate with specimen signature/s5. Local government permits and licenses (e.g. Mayor’s Permit, etc.)6. Photocopy of one (1) valid ID* of each signatories authorized by the corporation to enter into an agreement with BDO as specified in the Board Resolution/ Secretary’s Certificate

D. Additional Documents / Case to Case Requirement1. For Travel Agency: Photocopy of Certificate of Membership with any travel association2. Photocopy of Franchise Agreement or Certificate of Dealership if Trade or DBA Name is different from abovementioned documents3. For MOTO or Electronic Commerce (E-commerce): - Duly signed E-commerce Merchant Agreement (for E-commerce) or MOTO Agreement (for MOTO) - Photocopy of latest Audited Financial Statement / 6 months Bank Statements - Hold-out Deposit / Deed Of Assignment4. For RPS - Duly signed RPS Merchant Agreement5. For Eligible to tax exemption: - Photocopy of BIR Tax Exemption Certificate for NGO; or - Original or certified true copy of Tax Exemption Certificate issued by authorized government agency, e.g. PEZA, CDC, SBMA

* Valid IDs (Must Not Be Expired, Clear with Photograph and Signature) Passport (in case of foreign passport, must have English character / translations and the holder must have residence in the Philippines) Driver’s License Professional Regulations Commission (PRC) ID National Bureau of Investigation (NBI) Clearance Police Clearance (with dry seal of PNP) Philippine Postal ID Voter’s ID Barangay Certification (with dry seal from the barangay where it was issued) Government Service Insurance System (GSIS) e-Card New Social Security System (SSS) Card Senior Citizen ID Overseas Workers Welfare Administration (OWWA) ID OFW ID Seaman’s Book Alien Certificate of Registration (ACR) / Immigrant Certificate Registration (ICR) Government Office and GOCC IDs (e.g. AFD ID, Home Development Mutual Fund ID) Integrated Bar of the Philippines (IBP) ID Certification from the National Council for the Welfare of Disabled Persons (NCWDP) Department of Social Welfare and Development (DSWD) Certification Company IDs issued by private entities or institutions registered with or supervised or regulated by the BSP, SEC or Insurance Commission

Only application forms with complete documents will be processed.Please submit the following: