Company Details

1. FULL REGISTERED COMPANY NAME

2. COMPANY TYPE (PLEASE TICK ONE)

Private Company (LTD) Partnership (LLP)

Public Company (PLC) Sole Trader

Other (please specify)

3. REGISTERED COMPANY ADDRESS

NO. AND STREET NAME

CITY

COUNTRY

POSTAL CODE

4. REGISTERED TRADING ADDRESS

CHECK HERE IF SAME AS ABOVE

NO. AND STREET NAME

CITY

COUNTRY

POSTAL CODE

5. COMPANY REGISTRATION NUMBER

6. DATE OF INCORPORATION

7. EU VAT NUMBER

8. COMPANY PHONE NUMBER

9. PRIMARY EMAIL ADDRESS

10. APPLICANT WEBSITE/S

Merchant Application Form

SecureTrading Financial Services Limited (No: C56013), duly licensed by the MFSA to operate as a Financial Institution as defined in the Financial Institutions Act (Chapter 376, Laws of Malta)


VERSION 1.1


USER ID: These are required to enter into the Members Area, as required by the schemes in particular industries. Such as digital media/adult/wallets and cyberlockers.

PASSWORD: These are required to enter into the Members Area, as required by the schemes in particular industries. Such as digital media/adult/wallets and cyberlockers.

IP ADDRESS: These are required to enter into the Members Area, as required by the schemes in particular industries. Such as digital media/adult/wallets and cyberlockers.

11. COMPANY DESCRIPTION (PLEASE SPECIFY THE NATURE OF THE BUSINESS - PRODUCTS/SERVICES)

12. DESCRIPTOR

(NAME TO APPEAR ON CUSTOMER STATEMENTS FOR PURCHASES. THIS DESCRIPTOR IS SUBJECT TO INTERNAL APPROVAL. ANY CHANGES WILL BE COMMUNICATED TO YOU)

13. MERCHANT FULFILLMENT PERIOD

(SHIPPING AND HANDLING TIME)

14. DOES YOUR LINE OF BUSINESS REQUIRE A LICENSE?

IF YES, PLEASE PROVIDE US WITH A COPY. REFERENCE SHOULD BE MADE TO THE COMPANY SUPPORTIVE DOCUMENTS SECTION

yes no

15. DO YOU OFFER ANY AFFILIATES PROGRAMMES

(E.G WHITE-LABELLING)

yes no

IF YES, PLEASE SPECIFY

16. DO YOU OFFER AN E-WALLET?

yes no

IF YES PLEASE SPECIFY IF ITS A PASS THROUGH WALLET OR STAGED WALLET.

17. ARE YOU SUBJECT TO ANY BANKRUPTCY OR LEGAL PROCEEDINGS?

yes no

18. HOW MANY EMPLOYEES ARE CURRENTLY EMPLOYED?

Company Card Sales

19. PAYMENT CARD TYPES

Card not present - Moto ST Payme

Card not present - Ecom (secure) Apple Pay (secure)

Card not present - Ecom (unsecure)

20. ECOM 12 MONTH %

21. MOTO 12 MONTH %

22. PREVIOUS/CURRENT NAME OF PROCESSOR AND/OR ACQUIRER

23. REASON FOR CHANGE OF PROCESSOR AND/OR ACQUIRER

24. ALTERNATIVE PAYMENT METHODS

Alipay Bancontact EPS

Giropay iDeal My Bank

PayU Paysafecard Przelewy24

Qiwi Safetypay Sofort

Trustly

25. DO YOU PROCESS RECURRING TRANSACTIONS

Card not present - Moto ST Payme

26. CHOSEN VALUE (FOR REPORTING VALUES ON THIS APPLICATION)

Card not present - Moto ST Payme

27. AVERAGE TRANSACTION VALUE

Card not present - Moto ST Payme

28. CHARGEBACKS (% OF VOLUME) LAST 12 MONTHS

29. REFUND (% OF VOLUME) LAST 12 MONTHS

30. 12 MONTH VISA CARD EXPECTED VOLUME

31. 12 MONTH MASTERCARD EXPECTED VOLUME

Alternative Payment Methods

Payment Method Expected Turnover/Volume Average Transaction Value
Alipay
Bancontact
EPS
GiroPay
iDeal
My Bank
Payu
Paysafecard
Przelewy24
Qiwi
Safetypay
Sofort
Trustly

Company Bank Details

(Information below required for each Settlement Currency Bank Account)

32. ACCOUNT HOLDER NAME

33. BANK NAME

34. BANK ADDRESS

35. IBAN NUMBER

36. BIC NUMBER

37. ACCOUNT COUNTRY

38. ACCOUNT CURRENCY

39. SORT CODE (UK ONLY)

40. ROUTING NUMBER (US ONLY)

41. SETTLEMENT TYPE

* note: All Settlements will be Net of any fees or charges

Attach a copy of the company bank statement (dated within the last 3 months), showing the account holder name. This is required for each settlement currency bank account.

42. SETTLEMENT CURRENCY OPTION

Settlement Currency

Transacting Currency

L4L Currencies

Default Currencies

SEPA (EUR Only)

Directors & Shareholders Information

Full Name Job Title Date Of Birth Country Of Residence Nationality Home Address Identification No. Company Ownership % Are You A Director And/Or Owner? Political Exposed Person(or related)
1 Director
Owner
Yes
No
2 Director
Owner
Yes
No
3 Director
Owner
Yes
No
4 Director
Owner
Yes
No
5 Director
Owner
Yes
No
6 Director
Owner
Yes
No
7 Director
Owner
Yes
No

1. All Shareholders with 25% or more equity must be shown above.

2. If more than seven (7) principles directors and/or shareholders exist, please provide details on an additional separate sheet and attach.

3. Term ‘political exposed persons’ (“PEP”), is broad and generally includes all persons who fulfil a prominent public function and include his immediate family members or persons known to be close associates of such persons

Individual Information (Required for Shareholders and Authorised Signatory)

Additional Supportive Company Documents

ADDITIONAL DOCUMENTATION TO THE ABOVE MAY BE REQUIRED DURING THE APPLICATION PROCESS AND/OR FOLLOWING APPROVAL. IF DOCUMENTATION IS NOT PROVIDED IN ENGLISH, YOU MAY BE REQUIRED TO HAVE THE DOCUMENTATION TRANSLATED, AUTHENTICATED, NOTIRISED OR OTHERWISE.

IF THE ABOVE REQUESTED DOCUMENTS ARE NOT AVAILABLE IN ORIGINAL, CERTIFIED COPY OF THE ORIGINAL DOCUMENT AUTHENTICATED BY A NOTARY PUBLIC, ATTORNEY, PUBLIC ACCOUNTANT, TO BE A TRUE COPY OF ORIGINAL DOCUMENT IS REQUIRED.

PCI DSS Compliance

PCI DSS Certification Level

The Payment Card Industry Data Security Standard (PCI DSS) is a compliance requirement for merchants to enable safe payment transactions and ensure cardholder data is stored securely. Merchants that store cardholder data must be PCI DSS compliant or assume full liability for (i) cardholder losses caused by data theft, and (ii) any fines imposed by card schemes. More information can be found on https://www.pcisecuritystandards.org/pci_security/

PCI DSS is based on the total number of yearly credit card transactions processed.

Check One PCI Level Total Yearly Credit Card Transactions Redirect IFRAME Direct Post JavaScript XML Anything Else
1 Over 6 Million RoCA RoCA RoCAEP RoCAEP RoC RoC
2 1-6 Million SAQ A SAQ A SAQ A - EP SAQ A - EP SAQD SAQD
3 20,000 - 1 Million SAQ A SAQ A SAQ A - EP SAQ A - EP SAQD SAQD
4 Under 20,000 SAQ A SAQ A SAQ A - EP SAQ A - EP SAQD SAQD

Check if you are already PCI DSS compliant. A copy of your PCI DSS Certification, Self-Assessment Questionnaire and latest ASV scan must be provided.

Check if you would like to make use of STFS Portal for completing your PCI Self-Assessment Questionnaire. (Please note, fees apply to this service and will be agreed as part of your contract).

Declaration

By signing below and submitting this Application Form you acknowledge and agree:

a) You are applying for merchant acquiring services from SecureTrading Financial Services Limited (“STFS”);

b) You are authorised to submit this Application Form and all accompanying information;

c) It is within STFS’s discretion to approve or decline this application. STFS may decline this pplication without reason. If this application is approved, you will be required to enter an agreement for the provision of services and this Application Form will form part of the agreement;

d) All information provided as part of this Application Form (whether on this form or by other means) is true and correct. You may be required to provide further information. If there is any delay in providing any required information, STFS may not be able to approve your application. You will notify STFS if there is any material change in any information provided;

e) STFS is not liable for any loss incurred by you as a result of any action of STFS which either delays provision of the service to you, or results in your application being declined, when such actions are required by STFS to comply with its obligations under applicable laws and/or its internal policies and procedures;

f) You authorise STFS and its agents to perform credit checks, and any other checks as reasonably necessary, and exchange information obtained in such checks with third parties as reasonably required, to (i) assess this application and verify any information provided, (ii) manage provision of the services to you, and (iii) review your financial standing on a periodic basis; and

g) You are bound by the privacy policy which describes the handling of any personal data, including direct marketing. STFS is a subsidiary of UC Group Limited and STFS may exchange personal data with other companies in the UC Group as well as UC Group service providers. You can change your marketing preferences by calling +44 (0) 203 764 5050 or emailing dpofficer@securetradingfs.com.

Authorised Signatory:

Job Title:

Print Name:

Date: