MERCHANT APPLICATION FORM

MERCHANT ESTABLISHMENT DETAILS

ESTABLISHMENT NAME

MARKETING / DBA NAME

WEBSITE URL (if Available)

TYPE OF BUSINESS ENTITY Individual Sole Proprietor Partnership HUF Government Controlled/Owned

Private/Public Ltd Other (please specify)

ESTABLISHMENT PAN NO (In case of Propreitorship / Individual, owner's PAN to be mentioned)

GSTIN

REGISTERED OFFICE ADDRESS

LANDMARK

CITY STATE : PIN CODE :

INSTALLATION/OPERATION
Same as above
ADDRESS

LANDMARK

CITY STATE : PIN CODE :

CONTACT PERSON
NAME
(Store Contact Person)

MOBILE STD CODE TEL NO

EMAIL ID

MERCHANT
CATEGORY
(For Office Use Only)
FOR OFFICE USE ONLY
NATURE OF MCC
PRODUCTS &
SERVICES
TCC

OWNERSHIP DETAILS

NAME OF OWNER/PARTNER/DIRECTOR 1

RESIDENTIAL ADDRESS

Please affix recent

Photograph
LANDMARK

CITY PIN Code

STATE

MOBILE STD CODE TEL NO

EMAIL ID

AADHAR NO. - - PAN DATE OF BIRTH D D M M Y Y Y Y

NAME OF OWNER/PARTNER/DIRECTOR 2

RESIDENTIAL ADDRESS

Please affix recent

Photograph
LANDMARK

CITY PIN Code

STATE

MOBILE STD CODE TEL NO

EMAIL ID

AADHAR NO. - - PAN DATE OF BIRTH D D M M Y Y Y Y

Spice Digital Limited.622 -6th Floor, DLF Tower A Jasola,District Centre,New Delhi-110025 Tel: 0120-6113-786, Email:[email protected]
 BANK DETAILS OF MERCHANT

ACCOUNT NAME

ACCOUNT NUMBER ACCOUNT TYPE CURRENT ACCOUNT SAVINGS ACCOUNT

BANK NAME

BRANCH ADDRESS

IFSC CODE

NODAL BANK DETAILS

ACCOUNT NAME

ACCOUNT NUMBER

BANK NAME

BRANCH ADDRESS

IFSC CODE

PAYMENT DETAILS

TYPE OF DEVICE mPOS POS SMART POS No. of DEVICES

INSTALLATION FEERs. . GST Rs. . TOTAL AMOUNT Rs. .

PAYMENT MODE DATE

CARD RRN

CHEQUE / DD NO BANK NAME

NEFT / IMPS BANK NAME TRANSACTION REFERENCE NO.

*Draw in favour of *Spice Digital Limited..* (Note: Please make this payment at the time of handing over the Application Form)

RPC (Spice Digital Limited.. PER TRANSACTION CHARGES)

POS DEBIT CARD : UPTO Rs.2000 . % ABOVE Rs.2000 . %

POS CREDIT CARD : NORMAL CARDS* . % PREMIUM CARDS* . % POS AMEX . %

POS - Cash@POS TRANSACTION INCENTIVE : Rs. . POS EMI . %

WALLETS : . % UPI . %

MMC :

NOTE: 1. The above pricing is exclusive of applicable Taxes.

2. *As per thee classification of Card Scheme i.e. VISA , MASTER, AMEX, RUPAY ETC.
3. The details in this section is for information purposes only and these are rates applicable as on date of submitting this Applicationi Form.

TERMS, CONDITIONS & DECLARATION

I/We certify that the information and particulars provided above are correct and that the person/s signing this application has/have full legal authority to do so, on behalf of my/our Merchant Establishment. I/We agree to
abide by the terms & conditions in the separately signed Merchant Agreement. This application is an offer by Spice Digital Limited.. to me/us a prospective merchant and does not amount to acceptance or recruitment
of my/our Merchant Establishment, till the processing bank is satisfied with the application. This application is accepted pending scrutiny & verification by Spice Digital Limited.., Bank or their appointed agent(s), and
reserves the right to decline or cancel any application without assigning any reason whatsoever, and the processing bank's decision will be final and binding on me/us. I/We, by the way of signing this application, I/We
undestand that Spice Digital Limited.. per transaction charges (PPC) includes the charges for the value added services provided by Spice Digital Limited.. and the other charges payable to the respective stake holders
in processing the said transaction. I/We, by way of submission of this Application and the information requested therein, have evinced interest in enlisting for Merchant Acquiring Services, the scope of which will be
governed by the Merchant Establishment Agreement to be signed. The Spice Digital Limited.. Processing Bank reserves the rights to directly/indirectly verify all the information stated in this Application and to seek
credit references, including but not limited to CIBIL checks of the company as well as each of the owners/directors/authorised signatories for which we severally/jointly authorize the Acquiring bank to carry out for their
due diligence. If at any stage it is brought to the notice of the Spice Digital Limited.. that any information submitted herein is pressed/incorrect/false, or that it has been given with a view to wilfully mislead the Spice
Digital Limited.., the application is liable to be rejected and the Merchant Establishment Agreement shall also be terminated forthwith, without revoking the Spice Digital Limited..'s rights to proceed legally against

Signature - Merchant Authorised Signatory 1 Signature - Merchant Authorised Signatory 2

Sign & Stamp: Merchant Authorised Signatory 1 Sign & Stamp: Merchant Authorised Signatory 2

Full Name 1:________________________________________________________________________ Full Name 2:________________________________________________________________________

Date: ________________________________________________________________________ Date: ________________________________________________________________________

Place: ________________________________________________________________________ Place: ________________________________________________________________________

Spice Digital Limited.622 -6th Floor, DLF Tower A Jasola,District Centre,New Delhi -110025 Tel: 0120-6113-786, Email:[email protected]