As part of the review process for an application for membership of Visa Europe, Visa Europe carries out a risk review of the applicant. Part of the risk review involves reviewing the organisation’s business plan forecast for the next three years.
This form enables Visa Europe to capture required information about the organisation’s type, structure and business plan. Please tick relevant boxesand complete requested information.
Applicant Information Legal Name of Applicant: Category of Membership applied for:
Additional comments by Applicant (if any):
Payment Service Provider Category
Please indicate under which category of Payment Service Provider your organisation is authorised / regulated: Payment Service Provider:
Regulatory Authority
Please indicate the competent authority under which the applicant is regulated, whether Authorised or Registered by such competent authority, and which business activities related to card payments the applicant is permitted to perform. Please indicate if the applicant is also operating outside the country in which it is authorised under an EU passport, and in which countries.
Regulatory Authority: Activities Supervised by Regulator:
Domestic / Non-Domestic (Please List):
Payment Institution Only
Under Article 6 of the Payment Services Directive, please indicate the option for which the Applicant is qualified for initial capital:
Under Article 8 of the Payment Services Directive, please indicate the method for which the Applicant is qualified for calculation of own funds:
Branch Network
Please indicate any significant concentrations of branches. Number of Branches:
Main Location of Branches:
Customer Account Base
Domestic Currency Non-Domestic Currency Number of Consumer / Personal Accounts
Number of Business / Corporate Accounts Number of e-Accounts
Share Holding Ownership Structure
Please fill in the fields below to illustrate the structure of your company. If possible, also attach a chart showing the company ownership structure.
Share Holder Name Business Activity %
Executive Management Structure
Please fill in the fields below to illustrate the executive management of your company and attach an individual profile (CV) of each of the company’s management.
Total Assets
Please fill in the fields below to show the total assets of your company.
EURO Local Currency As of (Date)
Membership of Other Card Payment Scheme Please indicate if you are licensed to operate with a domestic scheme: If Yes, please indicate if issuing and/or acquiring with the domestic scheme:
Please indicate if you are operating a proprietary programme: Proprietary ATM only
Proprietary credit card Proprietary debit card Proprietary prepaid card
Visa Programmes
In this section provide details of the Visa programmes that you wish to implement. Complete this section if you plan to issue cards, indicating the date you plan to issue each programme and the projected number of cards issued at the end of years 1, 2 and 3.
Credit Card Issuance
Complete this section if you plan to issue cards, indicating the date you plan to issue each programme and the projected number of cards issued at the end of years 1, 2 and 3.
Start
Date Year 1 Year 2 Year 3 Physical Virtual
C ons um er Infinite - Plus - Visa Classic Visa Gold Visa Platinum C orpo ra te Visa Business Visa Corporate Visa Purchasing
Debit Card Issuance
Complete this section if you plan to issue cards, indicating the date you plan to issue each programme and the projected number of cards issued at the end of years 1, 2 and 3.
Start
Date Year 1 Year 2 Year 3 Physical Virtual
C ons um er Infinite - Visa Classic Visa Gold V PAY - Visa Platinum C orpo ra te Visa Business Visa Corporate Visa Purchasing TOTAL - - -
Credit Card Expenditure Volume
Complete this section if you plan to issue cards, indicating the date you plan to issue each programme and the projected number of cards issued at the end of years 1, 2 and 3.
Start Date Currency Year 1 Year 2 Year 3
C ons um er Infinite Plus Visa Classic Visa Gold Visa Platinum C orpo ra te Visa Business Visa Corporate Visa Purchasing TOTAL - -
Debit Card Expenditure Volume
Complete this section if you plan to issue cards, indicating the date you plan to issue each programme and the projected number of cards issued at the end of years 1, 2 and 3.
Start Date Currency Year 1 Year 2 Year 3
C ons ume r Infinite Visa Classic Visa Gold V PAY Visa Platinum C orpo ra te Visa Business Visa Corporate Visa Purchasing TOTAL - -
Prepaid Card Exposure
Complete this section if you intend to issue prepaid cards, indicating the date and currency of the programme, and the projected card numbers, maximum and average load, and the average daily balance remaining on the total portfolio across years one to three.
Start Date Currency Year 1 Year 2 Year 3
Cards Issued
Maximum Load Value Per Card/Per Currency
Average Load Value Per
Card / Per Currency
Total Card Expenditure Volume (CEV)
TOTAL
Please state the number and type of Prepaid programmes that you will be launching from the plan indicated above.
Number: Type:
Merchant Acquiring
Complete this section if you plan to enter into contractual relationships with merchants to accept Visa or V PAY cards.
Start Date Year 1 Year 2 Year 3
Visa Merchants V PAY Merchants POS Terminals
Merchant Categories to be Targeted – Sector & Country
(e.g. hotels, restaurants, petrol stations, supermarkets)
(Attach full breakdown)
Merchant Sales Volume
Complete this section if you plan to acquire cards, indicating the date you plan to start and the projected merchant sales volume base at the end of years 1, 2 and 3.
Start Date Currency Year 1 Year 2 Year 3
Visa Merchants V PAY Merchants Anticipated Chargebacks
TOTAL -
Cash Disbursement via ATMs
Complete this section if you plan to provide cash disbursement through your ATMs to Visa and/or PLUS cardholders.
Start Date Year 1 Year 2 Year 3
Visa ATMs Plus ATMs
Card Management Processing Plans Provide Details of Processing Arrangements:
Indicate how you plan to manage your programme:
If via an agent or Visa system processor, please provide Organisation Name: Contact Name: Mailing Address:
Telephone Number: Email Address:
