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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: