MERCHANT
REGISTRATION
FORM
Form No.:
Group :
Yes
No
Single :
Yes
No
Bin Switch: Yes
No
MERCHANT REGISTRATION FORM
PLEASE ENSURE THAT THE PRE-PRINTED INFORMATION IS CORRECT COMPLETE THE REMAINDER OF THE APPLICATION IN FULL IN BLOCK CAPITALS
Merchant ID
Trading Name:
Postal Address:
Trading Address:
Director details/Contact person (If different from director)
BANK ACCOUNT DETAILS (to be filled for Cash-in /Cash-out merchant)
Name:
Tel:
E-mail:
Mobile:
VAT No:
Company Reg. No:
Preferred Language: English
Kiswahili
TIN No:
Sole Proprietorship
Private Company
Registered Name (eg Smith & Jones Trading as)
Total number of POS required:
Other (Please specify):
Partnership
Freehold
Rented
Public Limited Company
Name of Bank:
Branch Name:
Account No:
Branch Code:
Name of Account:
Length of time with current bankers:
Type of Account:
Years
Month
BUSINESS DETAILS
Type of Business:
Type of premises agreement
If Rented, state length of lease (years):
When will lease expire?:
Date business commenced trading or due to commence trading:
Cards to be accepted
Are you part of a group?
Petroleum & Vehicles
Name of Group:
GPS Cord:
Number of Outlets:
Distributor
Travel & Entertainment
Financial Institution
Education
Retail
Government
Other
Yes
No
If yes please specify the name
B-Pesa
CUP
MERCHANT CATEGORY
PERSONAL INFORMATION (2)
(TO BE COMPLETED BY THE SOLE PROPRIETOR OR DIRECTORS/PARTNERS/MEMBERS)PERSONAL INFORMATION (1)
(TO BE COMPLETED BY THE SOLE PROPRIETOR OR DIRECTORS/PARTNERS/MEMBERS)Postal Code:
Postal Code:
Years
Month
ENCLOSURES
PLEASE ENCLOSE THE FOLLOWING DOCUMENTS WITH YOUR APPLICATION. FAILURE TO DO SO WILL RESULT IN YOUR APPLICATION BEING DELAYED.
DECLARATION
1. Copies of Proof of Identity
Yes
No
2. Copy of Address Proof
Yes
No
3. Copies of lease agreement
Yes
No
4. Certificate of Incorporation
Yes
No
5. Copy of VAT registration
Yes
No
6. Copy of TIN No.
Yes
No
Title :
Date of birth:
Surname:
ID No:
First name (s):
Years at current address:
Res. Address
PERSONAL BANKING DETAILS
applicant’s bank name:
Branch:
Postal Address
Account number:
Postal Address
Name of Account:
Account Manager:
Tel (H):
Account with current bankers:
Mr.
Mrs.
Miss.
Dr.
Prof.
Others
Postal Code:
Postal Code:
Years
Month
Title :
Date of birth:
Surname:
ID No:
Name:
Name:
Position held:
Position held:
Date:
Date:
Signature:
Signature:
First name (s):
Years at current address:
Res. Address
PERSONAL BANKING DETAILS
Name of applicant’s personal bank:
Branch Code:
Postal Address
Account number:
Postal Address
Name of Account:
Name of personal contact at Branch:
Tel (H):
Account with current bankers:
Mr.
Mrs.
Miss.
Dr.
Prof.
Others
*I/We authorise _________________________________________________ to make any enquiry that may deem necessary in connection with this application.
*I/We warrant that the above information is true and correct and that the conduct of business and any advertisements will be in conformity with the requirements of any relative legislation.
*I/We warrant that Merchant Services are sought for the business named in this application, and should Merchant Services facilities be granted I/we* undertake not to process sales vouchers or transactions on behalf of any third party individual or business.
*I/We further warrant that *I/we hold the authority to sign on behalf of the Business. *I/We authorise you to obtain a bankers status enquiry.
*Should I/we have indicated that I/we wish to accept cards issued by a member of any other card association cards, *I/we herby authorize Merchant Services to provide my/our bank account details to the relevant card issuers
For office use only
Yes
No
Yes
No
Merchant Approved:
Sales Approved:
Signature :
Signature :
Date
Date
Date
Date
Signature :
Yes
No
Merchant Captured:
Signature :
Yes
No
TC Notified:
MERCHANT CARD ACCOUNT DETAILS (to be filled for ALL )
Name on the merchant card:
Card No:
Expiry:
STANDARD TERMS OF AGREEMENT BETWEEN
SMART BANKING SOLUTIONS LTD AND ________________________________________________________________________________
THIS AGREEMENT is made the __________ day of ___________________, ______, by and between the parties (hereinafter called each separately “the Party” or collectively “the Parties”) Smart Banking Solutions LTD, having its registered head office at 2nd Floor, Amani Place, Ohio Street, Dar es Salaam, Tanzania (hereinafter called the “Principal”), And ___________________________________________, OF P. O. BOX __________________, ______________________________, Tanzania with (TIN no ___________________) with email: and mobile______________________________________________________ (Herein after called the “Merchant”) and _____________________________________ having is registered office is on _____________________________________________________________________________________________________________________, (Herein referred to as the ‘Bank’) PREAMBLE
The Principal is an authorised distributor of B-Pesa products and B-Pesa POS terminals on behalf of ___________________________________________ in Tanzania. The Principal desires to appoint the Merchant as a non-exclusive reseller of the B-Pesa Products and services. The Merchant is hereby accepting appointment as a reseller of B-Pesa Products and Services. 1. NOW IT IS HEREBY AGREED as follows:
1.1. The Principal shall install at its own cost a POS terminal at the Merchants premises, which is for the exclusive use at the Merchants premises for the purposes of B-Pesa Card Payment Acceptance, Cash-In, Cash-Out and Value Added Services (VAS) which will become available to the Merchant at the discretion of the Principal.
1.2. The Principal shall provide training to the Merchant on all current and future B-Pesa Products as well as the use of the POS terminal.
1.3. The Merchant will be assigned a unique identifier code: MERCHANT ID ____________________(to be filled by operation center) which, will be used as a reference number by the Merchant for all correspondence and payments.
1.4. The Merchant here by undertakes to maintain the POS terminal in a proper condition, and to report to the Principal any damage that may occur to the POS immediately upon such instance. In the event the merchant does not take due care of the POS device, the merchant will be surcharged the value of a new POS.
1.5. The merchant here by undertakes to obtain a police report in the event the POS device is stolen while in their possession. In the event they fail to do so, the merchant will be surcharged the cost of a new POS device.
2. FEE, COMMERCIAL & PAYMENT TERMS
2.1. The Merchant is required to deposit a float of Tsh________________________ which will be credited to the Merchants B-PESA trust account with the Bank. The Merchant is obligated to maintain a credit balance in his account at all times in order to offer products and services to its customers. (Only if offering full B-PESA Services)
2.2. The Merchant is entitled to a commission specified overleaf for all and any services rendered according to the agreement. No further fees or commission, indemnification or claim for this or for any other reason exists or may be exercised by the Merchant against the Principal. These commission are subject to change without notice.
2.3. The Principal agree that Collections done through its network on behalf of the merchants shall be paid at the end of the same banking working day (or the first working banking day in case loading and payments take place in non-working banking day) only into the bank account(s) of the Merchants as specified in the Merchant Registration form time to time in writing by the merchant.
2.4. The Bank agrees that all payments received by it on behalf of the Merchant shall be paid at the end of the same banking working day (or the first working banking day in case loading and payments take place in non-working banking day) only into the bank account(s) of the Merchant as specified in the Merchant Registration form.
3. OTHER TERMS AND CONDITIONS
3.1. The Principal reserves the absolute right for itself and any third party expressly appointed by it to advertise and promote the Products and Services during the term of this Agreement and following termination of this agreement with the Merchant as per clause 4 below.
3.2. The Merchant acknowledges that any equipment, software, or any other material provided by the Principal in relation to the product and services remains the property of the Principal and must be returned to the Principal upon first demand in good order as received.
4. TERMINATION
4.1. This Agreement shall continue until terminated with a written termination notice of 30 days by either party. Notice shall be by way of letter couriered to the address specified for a Party herein and/or hand delivered by the Principal’s operatives and acknowledged in writing by the Merchant, and shall be effective immediately upon delivery.
4.2. The Merchant agrees that it shall suspend further transaction loads for the applicable Program at the expiry of the termination period.
4.3. The Merchant agrees that it shall return to the Principal any and all equipment or material in the same good order and condition (with normal wear & tear due to proper usage) as provided to the Merchant upon first demand by the Principal.
4.4. The Principal shall release or return the Merchant’s dues or cash subject to the full reconciliation and final settlement of any and all transactions hereunder, all fees due and owed between the parties as per the agreement.
5. AMENDMENT
5.1. These standard terms may be amended on 7 days notice (in writing or by way of publication or e-mail of new standard terms to the Agent) from the Principal. In the event that the Merchant does not reject the revised terms in writing within that 7 day period the new terms shall be deemed to be the applicable terms under this Agreement.
6. NOTICES
6.1. Unless otherwise specified, all notices, requests, demands, approvals, consents and other communications under this Agreement ("Notices") shall be given in writing and shall be duly and validly given or made if given or served by hand or sent by facsimile transmission or pre-paid registered or recorded delivery post to the address of the relevant Party as stated herein or to any address subsequently notified by the relevant Party to the other Party in writing for such purpose.
7. GOVERNING LAW AND JURISDICTION
7.1. This Agreement and any dispute or claim arising out of or in connection with it or its subject matter or formation (including non-contractual disputes or claims) shall be governed by and construed in accordance with Tanzania law and the parties irrevocably agree that the courts of Dar es Salaam shall have non-exclusive jurisdiction to settle any dispute or claim that arises out of or in connection with this Agreement or its subject matter or formation (including non-contractual disputes or claims).
8. DECLARATION
8.1. I/We hereby confirm that I/We have read and understood the above stated terms and conditions. I/We further affirm that we will conform and adhere to the same terms and conditions as they appear above or as may be stipulated by the principal from time to time.
SMART BANKING SOLUTIONS LTD MERCHANT NAME :
SIGNED BY THE DULY AUTHORISED SIGNED BY THE WITNESS :
WITNESS NAME :
Tariff to card holder - POS Tariff
Value Range (TSH)
All Transaction will charge 1.25%
