SCAN TO PAY

MERCHANT APPLICATION FORM

Choose business structure (Individual, Sole Proprietorship, Partnership, or
MERCHANT INFORMATION Corporation) and provide applicable business information below

Sole Proprietorship Partnership Corporation

Corporate/Registered Name Business Trade Name
Business Address Unit No., Bldg Name, Street Name
Barangay / Subdivision / Village City / Municipality
Region / Province Country Zip Code
Business Days / Business Hours Tax Identification Number (TIN)
Contact Number Social Media / Website
(indicate Area Code or Mobile Prefix + Last 7 digits)
Business Industry
(Select one business industry)
Food Retail Transportation Entertainment Lifestyle E-commerce E-payments Others

Individual
Mobile Number for GCash Account Merchant Name
Business Address Unit No., Bldg Name, Street Name
Barangay / Subdivision / Village City / Municipality
Region / Province Country Zip Code
Business Industry
(Select one business industry) Food Retail Transportation Entertainment Lifestyle E-commerce E-payments Others

Registered Business Owner or Authorized

MERCHANT REPRESENTATIVE INFORMATION Representative

Full Name
Date of Birth Place of Birth Nationality
Contact Number Email Address
(indicate Area Code or Mobile Prefix + Last 7 digits)
Tax Identification Number (TIN) SSS Number
Current Address House/Unit No., Bldg Name, Street Name
Barangay / Subdivision / Village City / Municipality
Region / Province Country Zip Code
Permanent Address House/Unit No., Bldg Name, Street Name
Permanent Address Barangay / Subdivision / Village City / Municipality
is same as
Current Address
Region / Province Country Zip Code
Nature of Work Business Owner Company Representative (designation):
Source of Income Self Employed Employed Others
*For companies with more than one (1) authorized representative, kindly attach additional sheet/s to this form
If there are any individuals, companies, or government
ULTIMATE BENEFICIAL OWNER entities that own 20% or greater
PSE Code
Ownership Information First-tier Second-tier Higher-tier Controlling Ownership N/A (if registered)

Individual Ownership Information

Full Name Nature of Work Nationality
Address Source of Funds

Full Name Nature of Work Nationality

Address Source of Funds

Corporate Ownership Information

Legal Business Entity Name Website
City Country
Other businesses owned
and percentage

Legal Business Entity Name Website

City Country
Other businesses owned
and percentage
 SCAN TO PAY
MERCHANT APPLICATION FORM
CONFORME / TERMS AND CONDITIONS
CONFORME SCOPE OF SERVICE
This conforme serves as a deal sheet between G-Xchange, Inc. GCash Scan to Pay Service. GXI shall provide the Scan to Pay
(GXI) and the MERCHANT for the agreement covering the Service by enabling GCash Scan to Pay at each of the
commercial terms below for a period of 1 year. Once signed, a MERCHANT’s Scan to Pay Sites, which are stores or branches
memorandum of agreement, as applicable, shall be submitted owned or operated by MERCHANT where the Scan to Pay
by the partner within thirty (30) days upon wallet activation. Service will be installed and/or deployed. Once enabled, the
MERCHANT shall be able to accept payments from customers
COMMERCIAL TERMS who use the “GCash” mobile app in their smartphones to scan
No fee for service. GXI shall provide the Scan to Pay Service, the Quick Response (QR) Code featured at the relevant Scan to
and issue, install, and/or deploy the GCash Scan to Pay Tools Pay Site. To this end, GXI shall provide MERCHANT with the
free of charge. In exchange, no fee, cost, or expense shall be following for each Scan to Pay Site:
charged to GXI for the space used or occupied by the GCash o GCash Scan to Pay tools and promotional merchandise
Scan to Pay Tools. o SMS (text) message or e-mail notifications for each
No fee for GCash payments. No fee shall be charged to completed transaction, as well as capability to verify
customers for their use of GCash or of the GCash Scan to Pay transaction status via SMS syntax
feature to pay for their purchases at the Scan to Pay Sites. o Daily/Weekly/Monthly Transaction Reports, as applicable
Merchant Discount Rate. .GXI shall collect a Merchant Discount o Virtual GCash Wallet and Daily Bank Settlement for
Rate (MDR) as agreed in the contract, of all approved payment Non-Individual Accounts (within banking days only)
transactions made to MERCHANT through the Scan to Pay o One-time basic usage and troubleshooting training
Service. The MDR shall be implemented upon approval of the o Merchant Hotline
application. GXI may modify the implementation of the Scan to Pay Service
at any time, subject to timely notice of changes to MERCHANT.
PRE-SERVICE
Pre-Onboarding Requirements. Notwithstanding any proposal, USE OF THE SERVICE
term sheet, or application signed by the MERCHANT, GXI Intended purposes. MERCHANT shall use the Scan to Pay
reserves the right to cancel, delay, defer, or suspend delivery of Service and Scan to Pay Tools only for the intended purposes.
the Scan to Pay Service if the necessary pre-onboarding The Scan to Pay Service shall at all times be made available to
requirements (as communicated to MERCHANT) are not the public.
submitted on time or as requested. Pre-onboarding
requirements include basic national and local government USER AND DATA PRIVACY
registrations, basic corporate or legal documentation, and Information of or relating to users gathered through or on the
other relevant documents as may be required by GXI. Scan to Pay Service (including, without limitation, any
Grounds for Non-Delivery of the Scan to Pay Service. Even if information considered “personal information” or “sensitive
Pre-Onboarding Requirements have been provided to GXI personal information” under the Data Privacy Act of 2012) shall
and/or a proposal, term sheet, or an application has been be the exclusive property of GXI and will be dealt with in
signed by MERCHANT, GXI reserves the right not to proceed with accordance with GXI’s privacy and security policies, as well as
delivering the Scan to Pay Service (or, if already rendered, the relevant law and regulations. Under no circumstance shall
terminate or suspend the Scan to Pay Service), among others: GXI volunteer, disclose, or share to MERCHANT any personal
(a) if it is confirmed that the MERCHANT has made a information or sensitive personal information pertaining to
material misrepresentation or has concealed any GCash users, and in no event shall GXI process such personal
material information in its Pre-Onboarding information or sensitive personal information on behalf of
Requirements or in the proposal, term sheet, or MERCHANT. MERCHANT shall exert its own efforts in obtaining
application form; any necessary personal information or sensitive personal
(b) if the Site to be covered is outside of service coverage information from customers who are GCash users. Above
of Globe Telecom, Inc. (“Globe”) or is otherwise paragraphs notwithstanding, upon MERCHANT’s request, GXI
unavailable due to causes not attributable to Globe; or may share usage data from the Scan to Pay Service that is
(c) if MERCHANT is later found to be ineligible for the Scan aggregated and/or anonymized in such a way that individual
to Pay Service under GXI’s policies (such as when the users cannot be identified or ascertained, such as: (a) total
MERCHANT is blacklisted due to poor credit standing or number of customers who use GCash Scan to Pay, (b) average
has a history of fraudulent acts or practices). amount of e-money used for payments, and (c) average
volume of GCash payments per month.

SIGNATURE OF REGISTERED BUSINESS OWNER OR AUTHORIZED REPRESENTATIVE

By the signing of its authorized representative below, the MERCHANT (i) certifies that all the information provided
herein are true and correct; (ii) authorizes G-Xchange, Inc. (GXI) to update any and all of its records with GXI using
the information, (iii) authorizes GXI to validate all or part of the information related to its wallet from any sources, as
GXI may deem necessary, and (iv) agrees to the conforme / terms and conditions of the service indicated.

Full Name Signature

Business / Corporate Name Date

TO BE FILLED UP BY GCASH ACCOUNT MANAGER

I have checked and verified the supporting requirements against the original documents, and found them to be
authentic and in accordance with G-Xchange Inc requirements.

Account Manager Signature of Account Manager Date